Provider Demographics
NPI:1508821596
Name:MCCORMACK, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:MCCORMACK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1182 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1000
Mailing Address - Country:US
Mailing Address - Phone:518-713-5400
Mailing Address - Fax:518-713-5401
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1000
Practice Address - Country:US
Practice Address - Phone:518-713-5400
Practice Address - Fax:518-713-5401
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-05-21
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Provider Licenses
StateLicense IDTaxonomies
NY210406207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01861581Medicaid
E55563Medicare UPIN