Basic Information
| Provider Information | |||||||||
| NPI: | 1720510548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | GARRETT | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 GARRETT RD | ||||||||
| Address2: | |||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190261101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155463666 | ||||||||
| FaxNumber: | 2155466060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 GARRETT RD | ||||||||
| Address2: | |||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190261101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106235885 | ||||||||
| FaxNumber: | 6106237276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2017 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 71719 | WI | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | MD472924 | PA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.