Provider Demographics
NPI:1861870115
Name:MCINTOSH, MALLORY R (MD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:R
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2860 SW MISSION WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5604
Mailing Address - Country:US
Mailing Address - Phone:785-273-7571
Mailing Address - Fax:785-273-0524
Practice Address - Street 1:2860 SW MISSION WOODS DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5604
Practice Address - Country:US
Practice Address - Phone:785-273-7571
Practice Address - Fax:785-273-0524
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
KS04-40874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program