Provider Demographics
NPI:1982875506
Name:MAGUR, GARY BRIAN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:BRIAN
Last Name:MAGUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5883
Mailing Address - Country:US
Mailing Address - Phone:207-782-1809
Mailing Address - Fax:
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5883
Practice Address - Country:US
Practice Address - Phone:207-782-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1582101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor