Provider Demographics
NPI:1659334241
Name:MCINTOSH, VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W HILLSBORO BLVD STE 205
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1484
Mailing Address - Country:US
Mailing Address - Phone:954-428-3500
Mailing Address - Fax:954-428-1650
Practice Address - Street 1:3501 WEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-2000
Practice Address - Country:US
Practice Address - Phone:954-426-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 60356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF30066Medicare UPIN
FL15170YMedicare ID - Type Unspecified