Provider Demographics
NPI:1770683856
Name:MAGOWAN, KIRSTEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:P
Last Name:MAGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7278 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2649
Mailing Address - Country:US
Mailing Address - Phone:315-452-1712
Mailing Address - Fax:315-452-0394
Practice Address - Street 1:7278 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2649
Practice Address - Country:US
Practice Address - Phone:315-452-1712
Practice Address - Fax:315-452-0394
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180821208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01354801Medicaid
NY01354801Medicaid