Provider Demographics
NPI:1801047055
Name:NORMAN G. MCKOY MD & ASSOCIATES PA
Entity type:Organization
Organization Name:NORMAN G. MCKOY MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-336-9065
Mailing Address - Street 1:10274 LAKE ARBOR WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3146
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:20721-3146
Practice Address - Country:US
Practice Address - Phone:301-336-9065
Practice Address - Fax:301-336-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0733-0001OtherBLUECROSS BLUESHIELD-DC
MD0660019-00Medicaid
MD06980OtherAMERICAID
MD7946OtherBLUECROSS BLUESHIELD OF MARYLAND
MD7946OtherBLUECROSS BLUESHIELD OF MARYLAND
133541Medicare PIN