Provider Demographics
NPI:1619093697
Name:MCINTOSH, SUSAN GARFIELD (MAC,LAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GARFIELD
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MAC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-2136
Mailing Address - Country:US
Mailing Address - Phone:410-374-5637
Mailing Address - Fax:
Practice Address - Street 1:1421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2136
Practice Address - Country:US
Practice Address - Phone:410-374-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU000858171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist