Provider Demographics
NPI:1942362504
Name:MCCOY, SUSAN NAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EWING ST
Mailing Address - Street 2:SUITE C-13
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2757
Mailing Address - Country:US
Mailing Address - Phone:609-924-6899
Mailing Address - Fax:609-924-5759
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE C-13
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-924-6899
Practice Address - Fax:609-924-5759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB75441Medicare UPIN
NJ707091Medicare ID - Type Unspecified