Individual
RODERICK MACINTOSH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1101 NOTT ST, SCHENECTADY, NY 12308-2425
(518) 243-4000
Mailing address
1462 ERIE BLVD, SUITE 2, SCHENECTADY, NY 12305-1026
(518) 243-1500
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002263
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000405485002
BLUE SHIELD
NY
01
—
000495057001
BLUE SHIELD
NY
01
—
040511001098
FIDELIS CARE
NY
Enumeration date
07/17/2006
Last updated
07/08/2007
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