Provider Demographics
NPI:1740342013
Name:MACKINTOSH, BARBARA GENE (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:GENE
Last Name:MACKINTOSH
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 1:965 WHITE PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-261-2010
Mailing Address - Fax:203-261-2018
Practice Address - Street 1:950 CAMPBELL AVE # 240
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-479-8148
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001255886Medicaid
CT001255886Medicaid
CT110007352Medicare ID - Type Unspecified