Provider Demographics
NPI:1235172479
Name:MCGUIRE, KATHLEEN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5839
Mailing Address - Country:US
Mailing Address - Phone:203-375-9350
Mailing Address - Fax:
Practice Address - Street 1:2505 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-5839
Practice Address - Country:US
Practice Address - Phone:203-375-9350
Practice Address - Fax:203-375-8013
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT40110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061152058OtherCOMMERCIAL INSURANCE
CT001401108Medicaid
CT01004011CT01OtherBLUE CROSS/BLUE SHIELD
CTP3389562OtherOXFORD HEALTH PLAN
CT061152058OtherUNITED HEALTH CARE
CT223538OtherPREFERRED ONE
CT00140110800OtherBLUE CARE FFAMILY PLAN
CT040110OtherCONNECTICARE
CT3556550OtherAETNA HEALTH PLAN
CT061152058OtherCOMMUNITY HEALTH NETWORK
CT5189240OtherCIGNA HEALTH PLAN
CT2V4891OtherPHYSICIAN HEALTH SERVICES