Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036291 | CT |
N | 208600000X | Surgeon | 036291 | CT |
N | 208200000X | Surgeon | 75409 | MA |
N | 208600000X | Surgeon | 75409 | MA |
N | 208200000X | Surgeon | 9401 | RI |
N | 208600000X | Surgeon | 9401 | RI |
N | 2082S0105X | Plastic Hand Surgeon | 036291 | CT |
N | 2082S0105X | Plastic Hand Surgeon | 9401 | RI |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 042.0013287 | VT |
NPI | 1750488839 |
---|---|
Provider Name | Dr. Kevin Maguire |
First Address | Colchester, VT 05446 |
Second Address | Colchester, VT 05446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010036291CT01 | ANTHEM OF CT FEDERAL ID # (01) | CT |
010075409RI01 | ANTHEM BC OF CT ID # (01) | CT |
061485169 | TAX IDENTIFICATION NUMBER (01) | |
20437-6 | BCBS OF RI ID # (01) | RI |
401029 | BCBCHIP OF RI ID # (01) | RI |
G36120 | (02) | RI |
RI0846 | HEALTHNET-NONPAR ID # (01) | RI |