Provider Demographics
NPI:1437608247
Name:MCCOY, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 COUNTY HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SCHENEVUS
Mailing Address - State:NY
Mailing Address - Zip Code:12155
Mailing Address - Country:US
Mailing Address - Phone:607-267-1834
Mailing Address - Fax:
Practice Address - Street 1:2595 COUNTY HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SCHENEVUS
Practice Address - State:NY
Practice Address - Zip Code:12155
Practice Address - Country:US
Practice Address - Phone:607-267-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400717726172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver