Provider Demographics
NPI:1235397696
Name:MCGUIRE, KELLY KATHERINE (MD, MPA)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:KATHERINE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MD, MPA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KATHERINE
Other - Last Name:MCGUIRE MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPA
Mailing Address - Street 1:236 GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6913
Mailing Address - Country:US
Mailing Address - Phone:207-661-3600
Mailing Address - Fax:
Practice Address - Street 1:236 GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6913
Practice Address - Country:US
Practice Address - Phone:207-661-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-01
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254526-12084P0804X
MEMD206462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry