Provider Demographics
NPI:1124264288
Name:MACINTYRE, NEIL ROSS III (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:ROSS
Last Name:MACINTYRE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3787 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6148
Mailing Address - Country:US
Mailing Address - Phone:910-763-2361
Mailing Address - Fax:910-763-8804
Practice Address - Street 1:3787 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6148
Practice Address - Country:US
Practice Address - Phone:910-763-2361
Practice Address - Fax:910-763-8804
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2022-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT184153207X00000X
NC2010-01944207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916958Medicaid
NC2076979Medicare PIN