Provider Demographics
NPI:1508892480
Name:PRATT MCCOY, KIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:KIA
Middle Name:C
Last Name:PRATT MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIA
Other - Middle Name:C
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 ROUTE 73 N
Mailing Address - Street 2:40 LAKE CENTER DR SUITE 201A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3425
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-914-6180
Practice Address - Fax:609-914-6182
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246839207R00000X
NJ25MA08974600207R00000X
MDD86797208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2710668007Medicaid
FL2710668007Medicaid
FL50702WMedicare PIN