Provider Demographics
NPI:1477176097
Name:MAGUIRE, OWEN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:DAVID
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 BLAIR PARK RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7530
Mailing Address - Country:US
Mailing Address - Phone:802-847-1470
Mailing Address - Fax:
Practice Address - Street 1:353 BLAIR PARK RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7530
Practice Address - Country:US
Practice Address - Phone:802-847-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT060.0005573207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine