Provider Demographics
NPI:1912099235
Name:WILLIAM S. MAIGUR, MD
Entity Type:Organization
Organization Name:WILLIAM S. MAIGUR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAIGUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-752-4308
Mailing Address - Street 1:1434 MOUNT COBB RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3210
Mailing Address - Country:US
Mailing Address - Phone:570-752-4308
Mailing Address - Fax:
Practice Address - Street 1:1434 MOUNT COBB RD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-3210
Practice Address - Country:US
Practice Address - Phone:570-752-4308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031259L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B37487Medicare UPIN
PA128171Medicare ID - Type Unspecified