MEDICARE: DR. JOHN QUERQUES MD

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	2084P0800X	Psychiatry Physician	152871	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	S400231363	OTHER	MA	MEDICARE MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	771919	OTHER	MA	TUFTS HEALTH PLAN
3	J21116	OTHER	MA	BCBS MA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447240833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN QUERQUES MD

Provider Business Mailing Address
First Line	:	800 WASHINGTON ST
Second Line	:	BOX 1013
City	:	BOSTON
State	:	MA
Zip	:	02111-1552
Country	:	US
Telephone Number	:	617-636-5773
Fax Number	:	617-636-8442

Provider Business Practice Location Address
First Line	:	800 WASHINGTON ST
Second Line	:	BOX 1013
City	:	BOSTON
State	:	MA
Zip	:	02111-1552
Country	:	US
Telephone Number	:	617-636-5773
Fax Number	:	617-636-8442

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	09/15/2016

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