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NPI Code Detail

MEDICARE: DR. KENYA P MCINTOSH MD

MEDICARE: DR. KENYA P MCINTOSH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician90754SC
2207Q00000XFamily Medicine Physician273032NY
3207Q00000XFamily Medicine Physician2019-01610NC

General Provider Information

NPI Number : 1396768578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENYA P MCINTOSH MD
Provider Business Mailing Address
First Line : 300 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1118
Country : US
Telephone Number : 585-637-3905
Fax Number : 585-637-4990
Provider Business Practice Location Address
First Line : 5740 N GRAHAM ST
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-4839
Country : US
Telephone Number : 704-251-8340
Fax Number : 980-549-3832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 05/09/2024

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Directions to “ DR. KENYA P MCINTOSH MD” Practice Location

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