Healthcare Provider Details

I. General information

NPI: 1366851685
Provider Name (Legal Business Name): MCINTYRE & WHITING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 OAKWOOD DR
BRIDGEWATER VA
22812-9544
US

IV. Provider business mailing address

115 OAKWOOD DR
BRIDGEWATER VA
22812-9544
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-2343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number401412556
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number401412556
License Number StateVA

VIII. Authorized Official

Name: MS. BECKY MCINTYRE
Title or Position: OFFICE MANAGER
Credential:
Phone: 540-828-2343