Provider Demographics
NPI:1417182387
Name:JAMES F MCGUCKIN MD OF NC PA
Entity Type:Organization
Organization Name:JAMES F MCGUCKIN MD OF NC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:PO BOX 38574
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-8574
Mailing Address - Country:US
Mailing Address - Phone:215-382-3680
Mailing Address - Fax:215-382-3683
Practice Address - Street 1:3624 SHANNON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3772
Practice Address - Country:US
Practice Address - Phone:916-251-6605
Practice Address - Fax:919-251-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1574002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347351Medicare PIN