Provider Demographics
NPI:1053829796
Name:ECCARD, CODY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CODY
Middle Name:
Last Name:ECCARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 WATER COMPANY RD
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:MD
Mailing Address - Zip Code:21719-1924
Mailing Address - Country:US
Mailing Address - Phone:240-675-1154
Mailing Address - Fax:
Practice Address - Street 1:1355 EDWIN MILLER BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3703
Practice Address - Country:US
Practice Address - Phone:304-263-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-0068962084P0800X, 363A00000X
MDC0006734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry