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General NPI Number Information
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NPI Number | 1538635172
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Entity Type | Individual
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Provider Name | DERRICK MAURICE MCCOY ACUPUNCTURIST
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Gender | Male
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 1422 E JOPPA RD
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City | TOWSON
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State | MD
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Zip | 21286-5909
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Country | US
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Telephone | 443-983-7987
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 E JOPPA RD LOWR LEVEL
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City | TOWSON
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State | MD
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Zip | 21286-5909
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Country | US
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Telephone | 443-983-7987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04077
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U02426
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License Number State | MD
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