Provider Demographics
NPI:1548260714
Name:QUIN, GREGORY A (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:QUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:A
Other - Last Name:QUIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:302 N DUKE STREET
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1520
Mailing Address - Country:US
Mailing Address - Phone:765-472-3944
Mailing Address - Fax:765-472-3945
Practice Address - Street 1:302 N DUKE STREET
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1520
Practice Address - Country:US
Practice Address - Phone:765-472-3944
Practice Address - Fax:765-472-3945
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1045818173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252610Medicare PIN