Provider Demographics
NPI:1699840355
Name:MCKOY, NORMAN G (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:G
Last Name:MCKOY
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:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-2060
Mailing Address - Country:US
Mailing Address - Phone:301-336-9065
Mailing Address - Fax:301-336-6909
Practice Address - Street 1:10274 LAKE ARBOR WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721
Practice Address - Country:US
Practice Address - Phone:301-336-9065
Practice Address - Fax:301-336-6909
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD066001900Medicaid
E30169Medicare UPIN
MD563108Medicare PIN