Provider Demographics
NPI:1316154644
Name:MCGUIGAN, KELLY LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LORRAINE
Last Name:MCGUIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-8529
Mailing Address - Country:US
Mailing Address - Phone:609-315-4262
Mailing Address - Fax:
Practice Address - Street 1:101 RIDGELY AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1409
Practice Address - Country:US
Practice Address - Phone:410-280-0960
Practice Address - Fax:410-280-0963
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184233207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology