Provider Demographics
NPI:1750488839
Name:MAGUIRE, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
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 1:354 MOUNTAIN VIEW DR., 103
Mailing Address - Street 2:UVM MEDICAL CENTER, SURGERY/PLASTICS
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446
Mailing Address - Country:US
Mailing Address - Phone:802-847-3340
Mailing Address - Fax:802-847-7083
Practice Address - Street 1:354 MOUNTAIN VIEW DR., 103
Practice Address - Street 2:UVM MEDICAL CENTER, SURGERY/PLASTICS
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-847-3340
Practice Address - Fax:802-847-7083
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9401208200000X, 2082S0099X, 2082S0105X
CT036291208200000X, 2082S0099X, 2082S0105X
MA75409208200000X
VT042.00132872086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
061485169OtherTAX IDENTIFICATION NUMBER
CT010075409RI01OtherANTHEM BC OF CT ID #
CT010036291CT01OtherANTHEM OF CT FEDERAL ID #
RI20437-6OtherBCBS OF RI ID #
RI401029OtherBCBCHIP OF RI ID #
RIRI0846OtherHEALTHNET-NONPAR ID #
RIG36120Medicare UPIN
CT240000163Medicare ID - Type Unspecified
RI401029OtherBCBCHIP OF RI ID #