Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 036105475 | IL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 207205 | MA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | G78462 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | K9154 | TX |
NPI | 1003897703 |
---|---|
Provider Name | Jacquelyn A Quin |
First Address | West Roxbury, MA 02132-4927 |
Second Address | West Roxbury, MA 02132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 31/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036105475 | (05) | IL |
H23594 | (02) |