Healthcare Provider Details

I. General information

NPI: 1285702704
Provider Name (Legal Business Name): MALINDA M MCCOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NORTHCREEK DR
CINCINNATI OH
45236-2377
US

IV. Provider business mailing address

8240 NORTHCREEK DR
CINCINNATI OH
45236-2377
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7000
  • Fax: 513-246-5284
Mailing address:
  • Phone: 513-246-7000
  • Fax: 513-246-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG183800
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-05-7266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: