Provider Demographics
NPI:1932830452
Name:MCINTOSH, MICAH A (NUTRITIONIST)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:A
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8326
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-8326
Mailing Address - Country:US
Mailing Address - Phone:340-642-9191
Mailing Address - Fax:
Practice Address - Street 1:4060 ESTATE
Practice Address - Street 2:23 BEESTON HILL
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-51329-1L133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI2-51329-1LOtherTHE GOVERNMENT OF THE VIRGIN ISLANDS