Provider Demographics
NPI:1336646710
Name:MCCORCLE, CAMERON KENDAL SPIKE (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:KENDAL SPIKE
Last Name:MCCORCLE
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 1:55 ARCH ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1436
Mailing Address - Country:US
Mailing Address - Phone:339-375-3315
Mailing Address - Fax:339-375-7779
Practice Address - Street 1:55 ARCH ST STE 18
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1423
Practice Address - Country:US
Practice Address - Phone:339-375-3315
Practice Address - Fax:339-375-7779
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.142145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program