Provider Demographics
NPI:1639331911
Name:MCINTOSH, ERIN MARIE MALEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE MALEY
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:MALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:118 DOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2305
Mailing Address - Country:US
Mailing Address - Phone:937-593-5437
Mailing Address - Fax:937-593-0110
Practice Address - Street 1:118 DOWELL AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2305
Practice Address - Country:US
Practice Address - Phone:937-593-5437
Practice Address - Fax:937-593-0110
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3048188Medicaid