Provider Demographics
NPI:1477665768
Name:MCCOY, EMERY BRAD (DO, PLLC)
Entity Type:Individual
Prefix:
First Name:EMERY
Middle Name:BRAD
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DO, PLLC
Other - Prefix:
Other - First Name:E.
Other - Middle Name:BRAD
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, PLLC
Mailing Address - Street 1:3761A TEAYS VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9705
Mailing Address - Country:US
Mailing Address - Phone:304-760-8721
Mailing Address - Fax:304-760-8722
Practice Address - Street 1:3761A TEAYS VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9705
Practice Address - Country:US
Practice Address - Phone:304-760-8721
Practice Address - Fax:304-760-8722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001777930Medicaid
WV1477665768OtherMEDICARE RAILROAD
WV001777930Medicaid
WV4165941Medicare PIN