Provider Demographics
NPI:1588768709
Name:GUINAN, MARY G (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:GUINAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 WEST CENTER ST
Mailing Address - Street 2:MANCHESTER OBGYN ASSOC
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-645-6670
Mailing Address - Fax:860-645-8541
Practice Address - Street 1:388 WEST CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-649-1120
Practice Address - Fax:860-645-8541
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000227367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004224309Medicaid
NPP000Medicare UPIN
420000111Medicare ID - Type Unspecified