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NPI Code Detail

MEDICARE: DR. DIANE MCQUILLEN D.O.

MEDICARE: DR. DIANE MCQUILLEN D.O.
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
1207R00000XInternal Medicine PhysicianOS019488PA
2207R00000XInternal Medicine Physician25MB10720200NJ

General Provider Information

NPI Number : 1609262179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANE MCQUILLEN D.O.
Provider Business Mailing Address
First Line : PO BOX 1309
Second Line :
City : MARLTON
State : NJ
Zip : 08053-6309
Country : US
Telephone Number : 609-567-0200
Fax Number : 609-704-5615
Provider Business Practice Location Address
First Line : 3003 ENGLISH CREEK AVE STE C6
Second Line :
City : EGG HARBOR TOWNSHIP
State : NJ
Zip : 08234-4818
Country : US
Telephone Number : 609-481-3185
Fax Number : 609-704-5615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2015
Last Update Date : 04/01/2024

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Directions to “ DR. DIANE MCQUILLEN D.O.” Practice Location

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