Basic Information
| Provider Information | |||||||||
| NPI: | 1407185606 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUADRI MEDICAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | QUADRI MEDICAL LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9135 | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024469135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038939784 | ||||||||
| FaxNumber: | 6030893888 | ||||||||
| Practice Location | |||||||||
| Address1: | 2045 GRAND ARMY HWY | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027773932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083799700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 01/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | QUADRI | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4013165684 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1407185606 | 01 | MA | BCBS | OTHER | QU79574 | 05 | RI | MEDICAID | 110084579A | 05 | MA | MEDICAID | 1407185606 | 01 | RI | BLUE SHIELD | OTHER |