Provider Demographics
NPI:1447259940
Name:MAGUIRE, LAWRENCE C (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:MAGUIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-278-5926
Mailing Address - Fax:859-276-3189
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-278-5926
Practice Address - Fax:859-276-3189
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64200611Medicaid
C64389Medicare UPIN
KY64200611Medicaid