MEDICARE: MARY ROBIN MACINTYRE CNM, RN, NP

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	176B00000X	Midwife	000617-1	NY
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	360470-1	NY
3	367A00000X	Advanced Practice Midwife	000617	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000924350001	OTHER	NY	HEALTHNOW PROVIDER ID#
2	161568690	OTHER	NY	EMPIRE
3	7277063	OTHER	NY	AETNA PROVIDER ID NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P010000617	OTHER	NY	BLUE CHOICE
6	161568690	OTHER	NY	POMCO PROVIDER ID#
7	1899724	OTHER	NY	GHI PPO PROVIDER ID#

General Provider Information

NPI Number	:	1144217134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ROBIN MACINTYRE CNM, RN, NP

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-0553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 PORTLAND AVE
Second Line	:	STE 400
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3038
Country	:	US
Telephone Number	:	585-922-4200
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	11/19/2019

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