=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255502035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AYANA C MCINTOSH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2008
-----------------------------------------------------
Last Update Date | 02/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5530 WISCONSIN AVE SUITE 1550
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-220-1333
-----------------------------------------------------
Fax | 301-220-1533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13909 GLENLIVET GRV
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20707-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-796-9584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | D74972
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | D74972
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------