Provider Demographics
NPI:1578346011
Name:MCINTYRE, CALVIN
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
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 1:2538 S CRATER RD STE B
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2408
Mailing Address - Country:US
Mailing Address - Phone:804-732-0936
Mailing Address - Fax:
Practice Address - Street 1:2538 S CRATER RD STE B
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2408
Practice Address - Country:US
Practice Address - Phone:804-732-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach