Healthcare Provider Details

I. General information

NPI: 1598757312
Provider Name (Legal Business Name): MARGUERITE MCINTOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

245 N BINKLEY ST
SOLDOTNA AK
99669-7500
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax:
Mailing address:
  • Phone: 907-714-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2652
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: