Provider Demographics
NPI:1811095565
Name:MCGUCKIN, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:MCGUCKIN
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 1:14 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3322
Mailing Address - Country:US
Mailing Address - Phone:207-324-3226
Mailing Address - Fax:207-324-4088
Practice Address - Street 1:14 WINTER ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3322
Practice Address - Country:US
Practice Address - Phone:207-324-3226
Practice Address - Fax:207-324-4088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86878Medicare UPIN
ME089729Medicare ID - Type Unspecified