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Individual

CHARLES MCINTOSH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
405 W. GRAND AVENUE, DAYTON, OH 45405-4796
(937) 723-3210
(937) 748-1407
Mailing address
72 ROYAL BIRKDALE DR., SPRINGBORO, OH 45066-9597
(937) 748-1736
(937) 748-1407

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34004666
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000032022
BCBS
OH
05
0820857
OH
01
P00195301
RR MCR
Enumeration date
01/18/2007
Last updated
02/27/2008
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