Healthcare Provider Details

I. General information

NPI: 1285901223
Provider Name (Legal Business Name): PATRICK T MAGUIRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-7101
US

IV. Provider business mailing address

LAHEY HOSPITAL & MEDICAL CENTER 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-7061
  • Fax: 603-356-3942
Mailing address:
  • Phone: 781-744-8132
  • Fax: 781-744-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4660
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: