Healthcare Provider Details

I. General information

NPI: 1407851967
Provider Name (Legal Business Name): THOMAS EUGENE MCGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 N PEARL ST
NORTH EAST PA
16428-1926
US

IV. Provider business mailing address

2060 N PEARL ST
NORTH EAST PA
16428-1926
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-7711
  • Fax: 814-877-7715
Mailing address:
  • Phone: 814-877-7711
  • Fax: 814-877-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD029963E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: