Provider Demographics
NPI:1639257173
Name:MCINTYRE, ALICE G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:G
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36901 AMERICAN WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4057
Mailing Address - Country:US
Mailing Address - Phone:440-899-5550
Mailing Address - Fax:440-899-5674
Practice Address - Street 1:36901 AMERICAN WAY
Practice Address - Street 2:SUITE C
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4057
Practice Address - Country:US
Practice Address - Phone:440-899-5550
Practice Address - Fax:440-899-5674
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35085884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2588703Medicaid
OHI35822Medicare UPIN
OH2588703Medicaid