Basic Information
| Provider Information | |||||||||
| NPI: | 1750488839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGUIRE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 MOUNTAIN VIEW DR., 103 | ||||||||
| Address2: | UVM MEDICAL CENTER, SURGERY/PLASTICS | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028473340 | ||||||||
| FaxNumber: | 8028477083 | ||||||||
| Practice Location | |||||||||
| Address1: | 354 MOUNTAIN VIEW DR., 103 | ||||||||
| Address2: | UVM MEDICAL CENTER, SURGERY/PLASTICS | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028473340 | ||||||||
| FaxNumber: | 8028477083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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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 | 208200000X | 9401 | RI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 036291 | CT | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 75409 | MA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0099X | 9401 | RI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2082S0099X | 036291 | CT | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2082S0105X | 9401 | RI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 2082S0105X | 036291 | CT | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 2086S0122X | 042.0013287 | VT | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 061485169 | 01 | TAX IDENTIFICATION NUMBER | OTHER | 010075409RI01 | 01 | CT | ANTHEM BC OF CT ID # | OTHER | 010036291CT01 | 01 | CT | ANTHEM OF CT FEDERAL ID # | OTHER | 20437-6 | 01 | RI | BCBS OF RI ID # | OTHER | 401029 | 01 | RI | BCBCHIP OF RI ID # | OTHER | RI0846 | 01 | RI | HEALTHNET-NONPAR ID # | OTHER |