Provider Demographics
NPI:1972885010
Name:MCGUONE, DECLAN (MBCHB)
Entity type:Individual
Prefix:
First Name:DECLAN
Middle Name:
Last Name:MCGUONE
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YSM, BRADY MEMORIAL LABORATORY
Mailing Address - Street 2:310 CEDAR STREET, PO BOX 208023
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8023
Mailing Address - Country:US
Mailing Address - Phone:203-785-3624
Mailing Address - Fax:
Practice Address - Street 1:YALE PATHOLOGY
Practice Address - Street 2:20 YORK STREET, EP2-631
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-785-6424
Practice Address - Fax:203-785-3585
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-247485207ZP0102X
CT60303207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology