Provider Demographics
NPI:1366403818
Name:MCINTOSH, JOHN CLARKE (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CLARKE
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 1:2 WALDEN RIDGE DR
Mailing Address - Street 2:SUITE 20B
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8597
Mailing Address - Country:US
Mailing Address - Phone:828-258-7060
Mailing Address - Fax:
Practice Address - Street 1:2 WALDEN RIDGE DR
Practice Address - Street 2:SUITE 20B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8597
Practice Address - Country:US
Practice Address - Phone:828-258-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC365702080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2186269BMedicare ID - Type Unspecified
C76775Medicare UPIN