Provider Demographics
NPI:1679503106
Name:MCQUAIDE, BENJAMIN HOMER (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HOMER
Last Name:MCQUAIDE
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:PO BOX 1429
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-1429
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:781 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2408
Practice Address - Country:US
Practice Address - Phone:859-623-8827
Practice Address - Fax:859-623-8810
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64288863Medicaid
KY000000216573OtherANTHEM BLUE CROSS PIN
KYG04506OtherBLUEGRASS FAMILY HEALTH
KYG04506Medicare UPIN
KY0698802Medicare PIN