Provider Demographics
NPI:1437236387
Name:MCCORMICK, MARK G F (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G F
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 1:19000 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0712
Mailing Address - Country:US
Mailing Address - Phone:408-366-4400
Mailing Address - Fax:
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG821682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G821680Medicaid
00G821680Medicare ID - Type Unspecified
CA00G821680Medicaid