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NPI Code Detail

MEDICARE: SALLY S MCINTYRE MD

MEDICARE: SALLY S MCINTYRE 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
1207R00000XInternal Medicine Physician35.064669OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902845001
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLY S MCINTYRE MD
Provider Business Mailing Address
First Line : 2451 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-1893
Country : US
Telephone Number : 937-208-7377
Fax Number : 937-208-7375
Provider Business Practice Location Address
First Line : 2451 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-1893
Country : US
Telephone Number : 937-208-7377
Fax Number : 937-208-7375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 02/13/2013

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