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NPI Code Detail

MEDICARE: KENNETH L. MCCOY & ASSOCIATES

MEDICARE: KENNETH L. MCCOY & ASSOCIATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1649252826
Entity Type Code : Organization
Provider Name (Legal Business Name) : KENNETH L. MCCOY & ASSOCIATES
Provider Business Mailing Address
First Line : PO BOX 70688
Second Line :
City : WASHINGTON
State : DC
Zip : 20024
Country : US
Telephone Number : 410-872-9188
Fax Number : 410-872-9169
Provider Business Practice Location Address
First Line : 1150 VARNUM ST NE
Second Line : PATHOLOGY DEPATMENT
City : WASHINGTON
State : DC
Zip : 20017-2180
Country : US
Telephone Number : 410-872-9188
Fax Number : 410-872-9169
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL BRANCACCIO
Credential : MD
Telephone Number : 202-269-7242
Provider Enumeration Date : 11/15/2005
Last Update Date : 08/22/2020

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