Provider Demographics
NPI:1538156153
Name:QUINN, RAYFORD EDWIN (MD)
Entity type:Individual
Prefix:
First Name:RAYFORD
Middle Name:EDWIN
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118008
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:834-572-7727
Mailing Address - Fax:843-569-5881
Practice Address - Street 1:2550 ELMS CENTRE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-572-7727
Practice Address - Fax:843-569-5881
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18983207Q00000X
SC6407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969741Medicaid
SCN18983Medicaid
SCP00721743OtherRR MEDICARE
SCP00721743OtherRR MEDICARE
SCAA24657006Medicare PIN
NC201499BMedicare PIN
SCAA24655282Medicare PIN
SCAA24656868Medicare PIN
NC8969741Medicaid
SCN18983Medicaid
SCAA24655281Medicare PIN
SCAA24657126Medicare PIN
SCAA24658798Medicare PIN
SCAA70916834Medicare PIN
NCC80713Medicare UPIN