Basic Information
| Provider Information | |||||||||
| NPI: | 1659334241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 W HILLSBORO BLVD STE 205 | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544283500 | ||||||||
| FaxNumber: | 9544281650 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 WEST DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334422000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544261000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME 60356 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.