Provider Demographics
NPI:1679578736
Name:MCCOY, LANCE MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:MORGAN
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DUDLEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2105
Mailing Address - Country:US
Mailing Address - Phone:304-428-1114
Mailing Address - Fax:304-428-1135
Practice Address - Street 1:2801 DUDLEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2105
Practice Address - Country:US
Practice Address - Phone:304-428-1114
Practice Address - Fax:304-428-1135
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV191592084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2031447Medicaid
WV0116263002Medicaid
WV0830849Medicare PIN
WV0116263002Medicaid
OH4149071Medicare PIN