Provider Demographics
NPI:1104836022
Name:MCCORD, CARL W (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:MCCORD
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 1:950 N GLEBE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4173
Mailing Address - Country:US
Mailing Address - Phone:571-933-4662
Mailing Address - Fax:866-343-0947
Practice Address - Street 1:950 N GLEBE RD STE 700
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-4173
Practice Address - Country:US
Practice Address - Phone:571-933-4662
Practice Address - Fax:866-343-0947
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142535207Q00000X
SC18832207Q00000X
NC2014-02080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL8996OtherFL MEDICARE
SC188326Medicaid