MEDICARE: DR. MARY JOANNA MCINTYRE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	82783	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053301424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOANNA MCINTYRE M.D.

Provider Business Mailing Address
First Line	:	6505 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-3457
Country	:	US
Telephone Number	:	330-746-9200
Fax Number	:	330-746-9211

Provider Business Practice Location Address
First Line	:	6505 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-3457
Country	:	US
Telephone Number	:	330-746-9200
Fax Number	:	330-746-9211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/20/2010

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