Provider Demographics
NPI:1326196080
Name:RAYMOND G. MAGAURAN, M.D., P.C.
Entity Type:Organization
Organization Name:RAYMOND G. MAGAURAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAGAURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-255-9421
Mailing Address - Street 1:5 BAY STATE CT
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2120
Mailing Address - Country:US
Mailing Address - Phone:508-255-9421
Mailing Address - Fax:508-255-6702
Practice Address - Street 1:5 BAY STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2120
Practice Address - Country:US
Practice Address - Phone:508-255-9421
Practice Address - Fax:508-255-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78030207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9713191Medicaid
MAA29832Medicare ID - Type Unspecified
MA9713191Medicaid