Provider Demographics
NPI:1205819265
Name:MCCOY, PATRICIA MASSENGILL (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MASSENGILL
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 A PROVIDENCE MAIN STREET
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-5230
Mailing Address - Country:US
Mailing Address - Phone:256-382-2700
Mailing Address - Fax:
Practice Address - Street 1:100 PROVIDENCE MAIN ST NW
Practice Address - Street 2:2ND FLOOR STE 1E
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4826
Practice Address - Country:US
Practice Address - Phone:256-382-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180036882OtherRAILROAD MEDICARE
AL051009396OtherBLUE CROSS BLUE SHIELD
AL000009396OtherMEDICARE PTAN
AL000009396Medicaid
180036882OtherRAILROAD MEDICARE