Basic Information
| Provider Information | |||||||||
| NPI: | 1932183662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGUIRE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | BLAKE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 362 N BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502350 | ||||||||
| FaxNumber: | 5083502318 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COMPASS WAY | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | EAST BRIDGEWATER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023331465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083502150 | ||||||||
| FaxNumber: | 5083502151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 219717 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2030756 | 05 | MA | MEDICAID | 468720 | 01 | MA | TUFTS HEALTH PLAN | OTHER | J27056 | 01 | MA | BCBS MA | OTHER | RX3863 | 01 | MA | MEDCIARE PTAN | OTHER |