Individual
JONATHAN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7556 TEAGUE RD, SUITE 450, HANOVER, MD 21076-1213
(410) 553-8265
(410) 553-8267
Mailing address
PO BOX 64988, BALTIMORE, MD 21264-4988
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0055417
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441505100
—
MD
01
—
KC64AR R366 0007
BLUE CROSS
MD
Enumeration date
07/03/2006
Last updated
09/29/2011
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