Provider Demographics
NPI:1043493943
Name:MCCOY, THOMAS CRANE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CRANE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18861 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1914
Mailing Address - Country:US
Mailing Address - Phone:415-385-4089
Mailing Address - Fax:925-957-5401
Practice Address - Street 1:535 WELLINGTON WAY STE 330
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1331
Practice Address - Country:US
Practice Address - Phone:859-439-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05127207Q00000X
CA20A10130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine