Provider Demographics
NPI:1245271766
Name:MCGUIRE, KIMBERLY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCGUIRE
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 1:12 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3429
Mailing Address - Country:US
Mailing Address - Phone:201-725-4148
Mailing Address - Fax:732-671-5391
Practice Address - Street 1:12 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3429
Practice Address - Country:US
Practice Address - Phone:201-725-4148
Practice Address - Fax:732-671-5391
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA077476207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042447Medicaid
NJ082831DFHMedicare ID - Type Unspecified
NJI15593Medicare UPIN