Provider Demographics
NPI:1811976699
Name:MCINTOSH, DAVID K (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 N MAIN ST
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1511
Mailing Address - Country:US
Mailing Address - Phone:860-927-4875
Mailing Address - Fax:860-927-4366
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1511
Practice Address - Country:US
Practice Address - Phone:860-927-4875
Practice Address - Fax:860-927-4366
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038481208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001384817Medicaid
CTG07932Medicare UPIN
CT110008577Medicare ID - Type Unspecified