Healthcare Provider Details

I. General information

NPI: 1548248164
Provider Name (Legal Business Name): JOSE BERNARDO Q. QUINTOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPPIN ST CORO WEST SUITE 200
PROVIDENCE RI
02903-4141
US

IV. Provider business mailing address

593 EDDY ST HCH 122
PROVIDENCE RI
02903-1177
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5504
  • Fax: 401-444-2534
Mailing address:
  • Phone: 401-444-6195
  • Fax: 401-444-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD12262
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: