Provider Demographics
NPI:1952393043
Name:MCCOY, DAWN MARIA (MD)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6477 COLLEGE PARK SQ
Mailing Address - Street 2:STE 118
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:757-420-6218
Mailing Address - Fax:757-420-0487
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:STE 118
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-420-6218
Practice Address - Fax:757-420-0487
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052928208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6718272Medicaid
VA6718272Medicaid