Basic Information
Provider Information
NPI: 1518026020
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACINTYRE
FirstName: ANTHONY
MiddleName: GUNN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2150 PENNSYLVANIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200373201
CountryCode: US
TelephoneNumber: 2027412222
FaxNumber: 2027413396
Practice Location
Address1: 2150 PENNSYLVANIA AVE NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200373201
CountryCode: US
TelephoneNumber: 2027412222
FaxNumber: 2027413396
Other Information
ProviderEnumerationDate: 12/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XMD 21857DCY Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000XVA 0101052330VAN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000XD0051759MDN Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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