Basic Information
| Provider Information | |||||||||
| NPI: | 1407851967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 N PEARL ST | ||||||||
| Address2: | |||||||||
| City: | NORTH EAST | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164281926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777711 | ||||||||
| FaxNumber: | 8148777715 | ||||||||
| Practice Location | |||||||||
| Address1: | 2060 N PEARL ST | ||||||||
| Address2: | |||||||||
| City: | NORTH EAST | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164281926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777711 | ||||||||
| FaxNumber: | 8148777715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD029963E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02146427 | 01 | NY | NY MEDICAL ASSISTANCE | OTHER | 184879 | 01 | PA | BLUE SHIELD | OTHER | 080192127 | 01 | PA | RR MEDICARE | OTHER | 205103 | 01 | PA | UPMC | OTHER | 3163638 | 01 | PA | AETNA | OTHER | 0009591970010 | 05 | PA | MEDICAID | 75594 | 01 | PA | UNISON | OTHER | P001038 | 01 | PA | GATEWAY | OTHER | 00026194201 | 01 | NY | UNIVERA | OTHER | 2223623 | 01 | OH | OH MEDICAL ASSISTANCE | OTHER |