Healthcare Provider Details

I. General information

NPI: 1538635172
Provider Name (Legal Business Name): DERRICK MAURICE MCCOY ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 E JOPPA RD
TOWSON MD
21286-5909
US

IV. Provider business mailing address

1422 E JOPPA RD LOWR LEVEL
TOWSON MD
21286-5909
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-7987
  • Fax:
Mailing address:
  • Phone: 443-983-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02426
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM04077
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: