Healthcare Provider Details

I. General information

NPI: 1245233600
Provider Name (Legal Business Name): MARY CLARE GUIGLIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

IV. Provider business mailing address

250 FOUNTAIN CT
LEXINGTON KY
40509-1888
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-4444
  • Fax: 859-254-1814
Mailing address:
  • Phone: 859-263-4444
  • Fax: 859-254-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24001
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number24001
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: