Provider Demographics
NPI:1659983880
Name:MCCORMICK, LINDA BERNICE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:BERNICE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1929
Mailing Address - Country:US
Mailing Address - Phone:443-987-2099
Mailing Address - Fax:302-485-5204
Practice Address - Street 1:200 TYRONE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1929
Practice Address - Country:US
Practice Address - Phone:443-987-2099
Practice Address - Fax:302-485-5204
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2016601671332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies