Provider Demographics
NPI:1477656858
Name:CORMACK, FIONNUALA CATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:FIONNUALA
Middle Name:CATHRYN
Last Name:CORMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:BOX 359764
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-8998
Mailing Address - Fax:206-744-5087
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX 359764
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-8998
Practice Address - Fax:206-744-5087
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042866207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology