Healthcare Provider Details

I. General information

NPI: 1285664797
Provider Name (Legal Business Name): SEAN M QUINN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 CENTREVILLE RD
CHANTILLY VA
20151-3224
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 703-657-6925
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax: 301-921-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: