Healthcare Provider Details

I. General information

NPI: 1568625135
Provider Name (Legal Business Name): JOHN MARTIN QUILLIN PHD, MPH, MS, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E MARSHALL ST
RICHMOND VA
23298-5048
US

IV. Provider business mailing address

1101 E MARSHALL ST
RICHMOND VA
23298-5048
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-1925
  • Fax: 804-827-4100
Mailing address:
  • Phone: 804-628-1925
  • Fax: 804-827-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: