Provider Demographics
NPI:1538635172
Name:MCCOY, DERRICK MAURICE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:MAURICE
Last Name:MCCOY
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 E JOPPA RD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5909
Mailing Address - Country:US
Mailing Address - Phone:443-983-7987
Mailing Address - Fax:
Practice Address - Street 1:1422 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5909
Practice Address - Country:US
Practice Address - Phone:443-983-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04077225700000X
MDU02426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist