Healthcare Provider Details

I. General information

NPI: 1750488839
Provider Name (Legal Business Name): KEVIN MAGUIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MOUNTAIN VIEW DR., 103 UVM MEDICAL CENTER, SURGERY/PLASTICS
COLCHESTER VT
05446
US

IV. Provider business mailing address

354 MOUNTAIN VIEW DR., 103 UVM MEDICAL CENTER, SURGERY/PLASTICS
COLCHESTER VT
05446
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3340
  • Fax: 802-847-7083
Mailing address:
  • Phone: 802-847-3340
  • Fax: 802-847-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9401
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036291
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number75409
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number9401
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number036291
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number9401
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number036291
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number042.0013287
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: