Provider Demographics
NPI:1215060066
Name:MCCOY, ROBERT MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5550
Mailing Address - Fax:304-388-4352
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5550
Practice Address - Fax:304-388-4352
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19312207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001707115OtherBCBS
WV226371OtherCARELINK HEALTH PLAN
WVN1100GOtherHEALTHNET
WV0020009000Medicaid
220033058OtherRR MEDICARE
WV311440702OtherUPMC HEALTH PLAN
WVWV19312OtherTHE HEALTH PLAN
7949384OtherAETNA
WV311440702OtherMEDICAL MUTUAL
608911600OtherDEPT OF LABOR
WVN1100GOtherHEALTHNET
7949384OtherAETNA