Provider Demographics
NPI:1780066837
Name:MCCOY, CASSANDRA MARIE (DO)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 GRAYSON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6353
Mailing Address - Country:US
Mailing Address - Phone:540-962-8222
Mailing Address - Fax:
Practice Address - Street 1:810 GRAYSON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6353
Practice Address - Country:US
Practice Address - Phone:540-962-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205799207Q00000X
PAOT017386390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program