Provider Demographics
NPI:1720010929
Name:MCINTOSH, VIOLET M (MD)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:M
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 1:350 ENGLE STREET
Mailing Address - Street 2:THE BREAST CARE CENTER
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-894-3892
Mailing Address - Fax:201-894-3764
Practice Address - Street 1:350 ENGLE STREET
Practice Address - Street 2:THE BREAST CARE CENTER
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-3892
Practice Address - Fax:201-894-3764
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066655002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F82474Medicare UPIN
NJ002730Medicare ID - Type Unspecified
NJ7553803Medicare ID - Type Unspecified