MEDICARE: DR. AMY MACINTYRE MD

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	2084P0800X	Psychiatry Physician	MD418660	PA
2	2084P0804X	Child & Adolescent Psychiatry Physician	MD418660	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1681044	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1609035260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY MACINTYRE MD

Provider Business Mailing Address
First Line	:	111 PRESIDENTIAL BLVD
Second Line	:	SUITE 232
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1008
Country	:	US
Telephone Number	:	610-667-1781
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PRESIDENTIAL BLVD
Second Line	:	SUITE 232
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1008
Country	:	US
Telephone Number	:	610-667-1781
Fax Number	:

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

Provider Enumeration Date	:	06/08/2008
Last Update Date	:	06/08/2008

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