Provider Demographics
NPI:1689668584
Name:MAGUIRE, STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144E CURTIS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:S KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1461
Mailing Address - Country:US
Mailing Address - Phone:401-783-6940
Mailing Address - Fax:401-792-3676
Practice Address - Street 1:1144E CURTIS CORNER RD
Practice Address - Street 2:
Practice Address - City:S KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-1461
Practice Address - Country:US
Practice Address - Phone:401-783-6940
Practice Address - Fax:401-792-3676
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3214OtherBLUE CROSS/BLUE SHIELD
RI9003214Medicaid
RI3214OtherBLUE CROSS/BLUE SHIELD
089003214Medicare ID - Type Unspecified