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NPI Code Detail

MEDICARE: DR. TIMOTHY EDWARD QUAN M.D.

MEDICARE: DR. TIMOTHY EDWARD QUAN M.D.
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
1207RR0500XRheumatology Physician037380CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12771375OTHERCTCIGNA
2010037380CT04OTHERCTBLUE CROSS BLUE SHIELD
39924521OTHERCTAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649227208
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY EDWARD QUAN M.D.
Provider Business Mailing Address
First Line : 1504 SULLIVAN AVE
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2711
Country : US
Telephone Number : 860-432-8400
Fax Number : 860-432-8430
Provider Business Practice Location Address
First Line : 1504 SULLIVAN AVE
Second Line :
City : SOUTH WINDSOR
State : CT
Zip : 06074-2711
Country : US
Telephone Number : 860-432-8400
Fax Number : 860-432-8430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 06/17/2021

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