Provider Demographics
NPI:1427396399
Name:MCCORMICK, JILLIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2461
Mailing Address - Country:US
Mailing Address - Phone:412-655-8650
Mailing Address - Fax:412-655-6409
Practice Address - Street 1:2027 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2461
Practice Address - Country:US
Practice Address - Phone:412-655-8650
Practice Address - Fax:412-655-6409
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055896363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13808332OtherCAQH
PA13808332OtherCAQH