Healthcare Provider Details

I. General information

NPI: 1366305195
Provider Name (Legal Business Name): KRISTINE QUAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINE QUAM

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 OLD VIRGINIA ST.
URBANNA VA
23175
US

IV. Provider business mailing address

25200 MOUNT STERLING CT
MECHANICSVILLE MD
20659-4923
US

V. Phone/Fax

Practice location:
  • Phone: 804-758-2386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMT0138241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: