Provider Demographics
NPI:1982662565
Name:MCCOY, WAYMAN CORNELIUS (MD)
Entity Type:Individual
Prefix:
First Name:WAYMAN
Middle Name:CORNELIUS
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 1:120 GARDENVILLE PKWY W
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1324
Mailing Address - Country:US
Mailing Address - Phone:716-857-6150
Mailing Address - Fax:716-656-4074
Practice Address - Street 1:899 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-878-2700
Practice Address - Fax:716-504-5544
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084827208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010113803OtherUNIVERA #
NY000503171006OtherHEALTH NOW BCBS #
NY159894DLOtherPREFERRED CARE #
NY040426000155OtherFIDELIS CARE #
NY1200515OtherIHA #