Provider Demographics
NPI:1336487149
Name:MCCOUBRY, DEVIN (PA)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:MCCOUBRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:
Other - Last Name:FLANIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 FORT WASHINGTON AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1227
Mailing Address - Country:US
Mailing Address - Phone:845-489-6678
Mailing Address - Fax:
Practice Address - Street 1:245 FORT WASHINGTON AVE
Practice Address - Street 2:APT 2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1227
Practice Address - Country:US
Practice Address - Phone:845-489-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant