Provider Demographics
NPI:1205810983
Name:MCINTYRE, NICOLE K (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:K
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:K
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1908 HUNT CLUB LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-6548
Mailing Address - Country:US
Mailing Address - Phone:757-271-8565
Mailing Address - Fax:
Practice Address - Street 1:1040 UNIVERSITY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2650
Practice Address - Country:US
Practice Address - Phone:757-953-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050138207Y00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology