Provider Demographics
NPI:1447237607
Name:MCCOY, BLANE W (MD)
Entity Type:Individual
Prefix:
First Name:BLANE
Middle Name:W
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:STE. 100
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:440-842-1570
Mailing Address - Fax:440-842-8230
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-842-1570
Practice Address - Fax:440-842-8230
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35042919M207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514410Medicaid
OH0513931Medicare PIN
OHC02343Medicare UPIN
OH0513933Medicare PIN
OH0514410Medicaid