Provider Demographics
NPI:1013192848
Name:DOUGLAS C. MCCORKLE M.D., P.A.
Entity Type:Organization
Organization Name:DOUGLAS C. MCCORKLE M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:MCCORKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-363-7172
Mailing Address - Street 1:10 CROSSROADS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5458
Mailing Address - Country:US
Mailing Address - Phone:410-363-7172
Mailing Address - Fax:410-363-7188
Practice Address - Street 1:10 CROSSROADS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5458
Practice Address - Country:US
Practice Address - Phone:410-363-7172
Practice Address - Fax:410-363-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033742207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD51779OtherOPTIMUM CHOICE
MD3383624OtherUS HEALTHCARE
MD44425OtherIWIF
MD51779OtherMDIPA
MD1001599OtherUHC MEDICAID
MDKFN6DOOtherBCBS OF MD
MDP00093728OtherRAILROAD MEDICARE
MD4137034OtherAETNA
MD51779OtherMAMSI
MDJ1140001OtherBLUECHOICE
MDJ1140001OtherBCBS FEDERAL
MD1000254OtherUHC MEDICAID
MD42461004OtherBCBS OF MD
MD51779OtherONENET
MDJ1140001OtherBCBS FEDERAL
MD733MMedicare PIN