| Mccoy Medical Group Llc | |
|
4c North Ave Ste 403 Bel Air MD 21014-2333 | |
| (443) 377-8624 | |
| Not Available |
| Full Name | Mccoy Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4c North Ave Ste 403, Bel Air, Maryland |
| Authorized Official Name and Position | Derek A Mccoy (PRESIDENT) |
| Authorized Official Contact | 4433778264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mccoy Medical Group Llc Po Box 671 Bel Air MD 21014-0671 Ph: (443) 377-8264 | Mccoy Medical Group Llc 4c North Ave Ste 403 Bel Air MD 21014-2333 Ph: (443) 377-8624 |
| NPI Number | 1568179612 |
|---|---|
| Provider Enumeration Date | 10/28/2022 |
| Last Update Date | 08/29/2023 |
| Medicare PECOS PAC ID | 6709251176 |
|---|---|
| Medicare Enrollment ID | O20230417002997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568179612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Derek A Mccoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285827261 PECOS PAC ID: 2365595436 Enrollment ID: I20120618000250 |
| Provider Name | Jason Crowl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518520923 PECOS PAC ID: 3678802477 Enrollment ID: I20190904000409 |
| Provider Name | Kevin Donnelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740950054 PECOS PAC ID: 0648667154 Enrollment ID: I20220503000447 |
| Provider Name | Halea Blair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871249797 PECOS PAC ID: 8325421720 Enrollment ID: I20220817004026 |
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