Provider Demographics
NPI:1942596457
Name:MCINTYRE, MOLLY DALE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:DALE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:DALE
Other - Last Name:CRISPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:980 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2774
Mailing Address - Country:US
Mailing Address - Phone:412-262-4911
Mailing Address - Fax:
Practice Address - Street 1:980 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2774
Practice Address - Country:US
Practice Address - Phone:412-262-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical