MEDICARE: DR. NICOLE K MCINTYRE D.O.

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	207Y00000X	Otolaryngology Physician	0102050138	VA
2	207YS0012X	Sleep Medicine (Otolaryngology) Physician	0102050138	VA

General Provider Information

NPI Number	:	1205810983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE K MCINTYRE D.O.

Provider Business Mailing Address
First Line	:	1908 HUNT CLUB LN
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-6548
Country	:	US
Telephone Number	:	757-271-8565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 UNIVERSITY BLVD STE 205
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-2650
Country	:	US
Telephone Number	:	757-953-3502
Fax Number	:

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	01/14/2026

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