Provider Demographics
NPI:1003804527
Name:MCCOY, MARTHA TRIMBLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:TRIMBLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1416 WILLOW AVE
Mailing Address - Street 2:3B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2508
Mailing Address - Country:US
Mailing Address - Phone:502-357-0500
Mailing Address - Fax:
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 902
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3841
Practice Address - Country:US
Practice Address - Phone:502-583-5945
Practice Address - Fax:502-583-1804
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19174208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1274803Medicare ID - Type Unspecified
KYC69164Medicare UPIN