Healthcare Provider Details

I. General information

NPI: 1457350654
Provider Name (Legal Business Name): LASHAUNA MCINTOSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 STANTON CHRISTIANA RD STE 304
NEWARK DE
19713-2135
US

IV. Provider business mailing address

PO BOX 824804
PHILADELPHIA PA
19182-4804
US

V. Phone/Fax

Practice location:
  • Phone: 302-778-2229
  • Fax: 302-778-2250
Mailing address:
  • Phone: 302-691-3800
  • Fax: 302-778-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0005392
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: