Basic Information
| Provider Information | |||||||||
| NPI: | 1487788956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUAN | ||||||||
| FirstName: | REAGAN | ||||||||
| MiddleName: | WEI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 44055 RIVERSIDE PKWY STE 226 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201765177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039702670 | ||||||||
| FaxNumber: | 7039700240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101102774 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD448558 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 0101102774 | VA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2897463 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 67564400 | 05 | MD | MEDICAID | 420534 | 01 | PA | UPMC | OTHER | 102832761 | 05 | PA | MEDICAID | 30158392 | 01 | PA | AMERIHEALTH CARITAS - WMG | OTHER |