Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101268908 | VA |
N | 208600000X | Surgeon | 0101268908 | VA |
NPI | 1003202425 |
---|---|
Provider Name | Kristin Mccoy |
First Address | Roanoke, VA 24011-1713 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 21/07/2021 |