Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | D0073454 | MD |
NPI | 1285827261 |
---|---|
Provider Name | Dr. Derek Andrew Mccoy |
First Address | Bel Air, MD 21014 |
Second Address | Bel Air, MD 21014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
325119500 | (05) | MD |