Healthcare Provider Details

I. General information

NPI: 1932128980
Provider Name (Legal Business Name): RANDALL F MAGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD
WILLINGBORO NJ
08046
US

IV. Provider business mailing address

PO BOX 5075
CHERRY HILL NJ
08034-5075
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-3406
  • Fax: 856-616-1919
Mailing address:
  • Phone: 856-616-8100
  • Fax: 856-616-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMA44373
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: