Healthcare Provider Details

I. General information

NPI: 1730480872
Provider Name (Legal Business Name): JAMES F MCGUCKIN MD OF MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLD WASHINGTON RD STE 202
WALDORF MD
20602-3250
US

IV. Provider business mailing address

2929 ARCH ST SUITE 1750
PHILADELPHIA PA
19104-2866
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-3590
  • Fax:
Mailing address:
  • Phone: 215-382-3680
  • Fax: 215-240-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH SHARPE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 215-382-3680