Provider Demographics
NPI:1144552514
Name:MCINTOSH, ROGER GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GREGORY
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5158 BLACK HAWK RD
Mailing Address - Street 2:BLDG E-1570
Mailing Address - City:GUNPOWDER
Mailing Address - State:MD
Mailing Address - Zip Code:21010-5403
Mailing Address - Country:US
Mailing Address - Phone:410-417-2879
Mailing Address - Fax:410-436-4117
Practice Address - Street 1:5158 BLACK HAWK RD
Practice Address - Street 2:BLDG E-1570
Practice Address - City:GUNPOWDER
Practice Address - State:MD
Practice Address - Zip Code:21010-5403
Practice Address - Country:US
Practice Address - Phone:410-417-2879
Practice Address - Fax:410-436-4117
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2014-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00456562083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine