Provider Demographics
NPI:1063496982
Name:MCCORMICK, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCCORMICK
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 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:94 MENDON ST
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1311
Practice Address - Country:US
Practice Address - Phone:508-482-5401
Practice Address - Fax:508-482-5402
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74282207R00000X, 207RC0200X, 207RP1001X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108805Medicaid
MA3108805Medicaid
MAMC J13835Medicare ID - Type Unspecified