Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | D0083031 | MD |
NPI | 1376836015 |
---|---|
Provider Name | Kevin Mccoy |
First Address | Syracuse, NY 13210 |
Second Address | Easton, MD 21601-3883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 17/03/2018 |