Provider Demographics
NPI:1932183662
Name:MAGUIRE, SANDRA BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:BLAKE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2150
Practice Address - Fax:508-350-2151
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219717208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2030756Medicaid
MA468720OtherTUFTS HEALTH PLAN
MAJ27056OtherBCBS MA
MARX3863OtherMEDCIARE PTAN
MAJ27056OtherBCBS MA
MA2030756Medicaid