Provider Demographics
NPI:1447842158
Name:MCINTYRE, DEMARCUS DERVON
Entity type:Individual
Prefix:
First Name:DEMARCUS
Middle Name:DERVON
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 SAVANNAH ST SE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7527
Mailing Address - Country:US
Mailing Address - Phone:240-501-4866
Mailing Address - Fax:
Practice Address - Street 1:2004 SAVANNAH ST SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7527
Practice Address - Country:US
Practice Address - Phone:202-422-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant