Provider Demographics
NPI:1538115415
Name:MCCORMICK, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
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 1:200 S BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-631-1535
Mailing Address - Fax:914-631-7654
Practice Address - Street 1:100 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5694
Practice Address - Country:US
Practice Address - Phone:914-373-4948
Practice Address - Fax:914-941-4669
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189460-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01853130Medicaid
NY56K271Medicare ID - Type Unspecified
NY01853130Medicaid
NYA400026748Medicare PIN