Provider Demographics
NPI:1407257694
Name:MAGUIRE ALLERGY PRACTICELLC
Entity Type:Organization
Organization Name:MAGUIRE ALLERGY PRACTICELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:508-675-1769
Mailing Address - Street 1:851 MIDDLE ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1778
Mailing Address - Country:US
Mailing Address - Phone:508-675-1769
Mailing Address - Fax:508-324-6824
Practice Address - Street 1:851 MIDDLE ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1778
Practice Address - Country:US
Practice Address - Phone:508-675-1769
Practice Address - Fax:508-324-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51526207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE02056Medicare UPIN