Organization
QUINCY PHYSICIAN CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA DIVAIO-BUSH (DIRECTOR PHYSICIAN SERVICES)
(617) 376-4018
Entity
Organization
Contact information
Practice address
114 WHITWELL ST, QUINCY, MA 02169-1870
(617) 376-4018
(617) 376-1609
Mailing address
114 WHITWELL ST, QUINCY, MA 02169-1870
(617) 376-4018
(617) 376-1609
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
06/22/2007
Last updated
07/20/2007
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