Healthcare Provider Details

I. General information

NPI: 1093247306
Provider Name (Legal Business Name): COURTNEY MCGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

IV. Provider business mailing address

800 WASHINGTON ST # 1013
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1559
  • Fax:
Mailing address:
  • Phone: 617-636-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number283549
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: