Provider Demographics
NPI:1841464948
Name:RANIRE MAGUIRE, MARISA (MD)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:RANIRE MAGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:RANIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1999 MARCUS AVE STE M6
Mailing Address - Street 2:
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-233-3780
Mailing Address - Fax:516-233-3788
Practice Address - Street 1:1999 MARCUS AVE STE M6
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-233-3780
Practice Address - Fax:516-233-3788
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245527208C00000X
NY245527-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery