Provider Demographics
NPI:1861475725
Name:MCINTYRE, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1940 BRIARWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5497
Mailing Address - Country:US
Mailing Address - Phone:828-294-1116
Mailing Address - Fax:828-294-0096
Practice Address - Street 1:1940 BRIARWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5497
Practice Address - Country:US
Practice Address - Phone:828-294-1116
Practice Address - Fax:828-294-0096
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0093-00230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8956809Medicaid
NC56809OtherBLUE CROSS BLUE SHIELD
NCA99695Medicare UPIN
NC8956809Medicaid