MEDICARE: KIMBERLY QUINN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053737171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY QUINN

Provider Business Mailing Address
First Line	:	1808 DELANCEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6607
Country	:	US
Telephone Number	:	267-838-4599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 DELANCEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6607
Country	:	US
Telephone Number	:	267-838-4599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	03/13/2014

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Directions to “ KIMBERLY QUINN ” Practice Location

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