MEDICARE: OSCAR R QUEZADA 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
1	207V00000X	Obstetrics & Gynecology Physician	273139	NY
2	207V00000X	Obstetrics & Gynecology Physician	K7471	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	273139	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1770670945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSCAR R QUEZADA M.D.

Provider Business Mailing Address
First Line	:	6 BEATTY RD
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1053
Country	:	US
Telephone Number	:	915-227-2117
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 MAIN RD
Second Line	:
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-1953
Country	:	US
Telephone Number	:	361-727-4950
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	10/17/2020

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