Provider Demographics
NPI:1235304254
Name:MCCOY, RODERICK LAWRENCE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:LAWRENCE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 BEACON ST
Mailing Address - Street 2:UNIT 590633
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-5900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4308
Practice Address - Country:US
Practice Address - Phone:617-349-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine