Healthcare Provider Details

I. General information

NPI: 1679503106
Provider Name (Legal Business Name): BENJAMIN HOMER MCQUAIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 EASTERN BYP
RICHMOND KY
40475-2408
US

IV. Provider business mailing address

PO BOX 1429
FRANKFORT KY
40602-1429
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-8827
  • Fax: 859-623-8810
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28886
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: