Healthcare Provider Details

I. General information

NPI: 1053301424
Provider Name (Legal Business Name): MARY JOANNA MCINTYRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JOANNA GOCALA M.D.

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COTTAGE GROVE RD
BLOOMFIELD CT
06002-2920
US

IV. Provider business mailing address

900 COTTAGE GROVE RD
BLOOMFIELD CT
06002-2920
US

V. Phone/Fax

Practice location:
  • Phone: 800-400-6354
  • Fax:
Mailing address:
  • Phone: 800-400-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: