Provider Demographics
NPI:1467137828
Name:MCINTYRE, WILLIAM WALDEN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALDEN
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 TELFAIR BLVD APT F305
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4266
Mailing Address - Country:US
Mailing Address - Phone:202-760-9577
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1849
Practice Address - Country:US
Practice Address - Phone:202-506-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC224175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist