Provider Demographics
NPI:1205834967
Name:MCCORMICK, MARK W (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
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 1:2 HOT METAL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:
Practice Address - Street 1:690 STATE AVE
Practice Address - Street 2:
Practice Address - City:VANPORT
Practice Address - State:PA
Practice Address - Zip Code:15009-9501
Practice Address - Country:US
Practice Address - Phone:724-728-7810
Practice Address - Fax:724-728-3852
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017961E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0690726Medicaid
PA0690726Medicaid
PAC32905Medicare UPIN