Basic Information
| Provider Information | |||||||||
| NPI: | 1003804527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | TRIMBLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1416 WILLOW AVE | ||||||||
| Address2: | 3B | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402042508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023570500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 ABRAHAM FLEXNER WAY | ||||||||
| Address2: | STE 902 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025835945 | ||||||||
| FaxNumber: | 5025831804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 19174 | KY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.