1801047055 NPI number — NORMAN G. MCKOY MD & ASSOCIATES PA

Table of content: (NPI 1801047055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801047055 NPI number — NORMAN G. MCKOY MD & ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN G. MCKOY MD & ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801047055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10274 LAKE ARBOR WAY
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MITCHELLVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-336-9065
Provider Business Mailing Address Fax Number:
301-336-6909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10274 LAKE ARBOR WAY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MITCHELLVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20721-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-336-9065
Provider Business Practice Location Address Fax Number:
301-336-6909
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCKOY
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
301-336-9065

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D35947 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0733-0001 . This is a "BLUECROSS BLUESHIELD-DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 0660019-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06980 . This is a "AMERICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7946 . This is a "BLUECROSS BLUESHIELD OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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