NPIMap

Individual provider Active NPI

Cody Eccard, PA-C

  • Physician Assistant
  • Fulton, MD
National Provider Identifier
1053829796
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110-006896 Issued in VA
Practice address
8115 Maple Lawn Blvd Ste 350
Fulton, MD 20759-2683
Phone
(551) 295-8223
NPI assigned
Jan 16, 2018
Last updated
Dec 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0006734 MD
Physician Assistant 363A00000X 0110-006896 VA Primary
Psychiatry Physician 2084P0800X 0110-006896 VA

Addresses

Primary practice location

8115 Maple Lawn Blvd Ste 350
Fulton, MD 20759-2683

Mailing address

14611 Water Company Rd
Cascade, MD 21719-1924
Phone (240) 675-1154

Other practice location 1

1355 Edwin Miller Blvd
Martinsburg, WV 25404-3703
Phone (304) 263-6753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180216001877 MD Practitioner - Physician Assistant 6305106196 Reassigns benefits to 4 organizations
I20220503002074 DC Practitioner - Physician Assistant 6305106196 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ennoble HC DMV LLCGroup PAC ID 9032517925, 112 clinicians

Practice addresses (Care Compare)

39 V St NE
Washington, DC 20002-1329
Phone (862) 812-9010

8115 Maple Lawn Blvd
Suite 350
Fulton, MD 20759-2683
Phone (973) 435-9463

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0006734MDMDPhysician Assistant
0110-006896VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ennoble HC DMV II LLC CurrentSince Oct 8, 2025 Accepting new patients
Ennoble HC DMV III LLC CurrentSince Oct 28, 2025 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1500 K St NW
Fl 2
Washington, DC 20005
Phone (212) 287-4257

1500 K St NW
Ofc 226A
Washington, DC 20005
Phone (862) 812-9010

8115 Maple Lawn Blvd
Ste 350
Fulton, MD 20759
Phone (240) 744-0001

2 University Plz
Ste 204
Hackensack, NJ 07601
Phone (201) 564-0142

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766448000000",
    "number": "1053829796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14611 WATER COMPANY RD",
            "city": "CASCADE",
            "state": "MD",
            "postal_code": "217191924",
            "telephone_number": "240-675-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8115 MAPLE LAWN BLVD STE 350",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592683",
            "telephone_number": "551-295-8223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1355 Edwin Miller Blvd",
            "address_purpose": "LOCATION",
            "city": "Martinsburg",
            "state": "WV",
            "postal_code": "254043703",
            "country_code": "US",
            "telephone_number": "304-263-6753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ECCARD",
        "first_name": "CODY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-16",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0006734",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-006896",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0110-006896",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, MD

Sources for this page

Verify at the official NPI Registry.