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General NPI Number Information
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NPI Number | 1720597537
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Entity Type | Organization
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Legal Business Name | QUINCY PRIMARY HEALTHCARE PC
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 300 CONGRESS ST STE 203
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City | QUINCY
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State | MA
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Zip | 02169-0907
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Country | US
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Telephone | 617-481-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 33 POND AVE APT 708
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City | BROOKLINE
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State | MA
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Zip | 02445-7156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAN TAN
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Credential | MD
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Telephone | 347-429-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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