Healthcare Provider Details

I. General information

NPI: 1467654202
Provider Name (Legal Business Name): ROSS B.L. MACINTYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 01/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST MAUMENEE 317
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64481
BALTIMORE MD
21264-4481
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberLP01182
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD70313
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: