Provider Demographics
NPI:1922081447
Name:MCCOY, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
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 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-438-5950
Mailing Address - Fax:401-435-2561
Practice Address - Street 1:318 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-438-5950
Practice Address - Fax:401-435-2561
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7312207RN0300X
MA54730207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI201149OtherBLUE CHIP
MA110047054BMedicaid
1487OtherNEIGHBORHOOD
RI7000736Medicaid
MA00000003716OtherBOSTON MEDICAL
1220212002OtherCIGNA
3085902OtherMA WELFARE
MAJ08648OtherBLUE CROSS
054730OtherTUFTS
3100113OtherUNITED
10015RIHOtherHARVARD PILGRIM
390001779OtherRAILROAD MEDICARE
RI7312OtherBLUE CROSS
MAJ08648OtherBLUE CROSS
3100113OtherUNITED
D87404Medicare UPIN