Healthcare Provider Details

I. General information

NPI: 1306639240
Provider Name (Legal Business Name): MARIAH KATE MCINTYRE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD
CAPE CORAL FL
33990-2695
US

IV. Provider business mailing address

44 BAYBERRY DR
BALLSTON SPA NY
12020-6308
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-3743
  • Fax:
Mailing address:
  • Phone: 716-201-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO11241
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberUO11241
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT024561
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: