Provider Demographics
NPI:1356309819
Name:MCCOY, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-349-1630
Mailing Address - Fax:724-349-5713
Practice Address - Street 1:841 HOSPITAL ROAD
Practice Address - Street 2:SUITE 2600
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-1630
Practice Address - Fax:724-349-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022344E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C28450Medicare UPIN
PA110622Medicare ID - Type Unspecified