NPIMap

Organization Active NPI

Quantum Rehabilitation Medicine

  • Physical Medicine & Rehabilitation Physician
  • Glenn Dale, MD
National Provider Identifier
1962043760
Registry record updated Mar 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
QUANTUM REHABILITATION MEDICINE
Practice address
12150 Annapolis Rd Ste 211
Glenn Dale, MD 20769-9183
Phone
(410) 685-1188
Fax
(410) 685-1889
NPI assigned
Oct 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Doriscine Colley, MD
Title
Medical Director
Phone
(443) 315-6359

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

12150 Annapolis Rd Ste 211
Glenn Dale, MD 20769-9183

Mailing address

PO Box 6553
Columbia, MD 21045-6553
Phone (443) 315-6359

Other practice location 1

4 N Exeter St Ste 102
Baltimore, MD 21202-4711
Phone (410) 685-1188

Other identifiers 1

IdentifierTypeStateIssuer
1619002649MedicaidMD

Other names 1

  • none Former legal business name

National Provider Directory

National Provider Directory

Locations

4 N Exeter St
Ste 102
Baltimore, MD 21202
Phone (410) 685-1188

12150 Annapolis Rd
Ste 211
Glenn Dale, MD 20769
Phone (240) 206-0621

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585353600000",
    "number": "1962043760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6553",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210456553",
            "telephone_number": "443-315-6359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD STE 211",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699183",
            "telephone_number": "410-685-1188",
            "fax_number": "410-685-1889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 N Exeter St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212024711",
            "country_code": "US",
            "telephone_number": "410-685-1188",
            "fax_number": "410-685-1889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "QUANTUM REHABILITATION MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2020-03-28",
        "certification_date": "2020-03-28",
        "status": "A",
        "authorized_official_last_name": "COLLEY",
        "authorized_official_first_name": "DORISCINE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "443-315-6359",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619002649",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "none",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.