Provider Demographics
NPI:1518922640
Name:MCINCROW, RICHARD R (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:MCINCROW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:912-303-3506
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:SUITE 424
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-819-8939
Practice Address - Fax:912-819-5980
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA059099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA802611971AMedicaid
GABM6682682OtherDEA
GA20211I2397Medicare PIN
GA11SCHHDMedicare PIN
GABM6682682OtherDEA