Provider Demographics
NPI:1669486239
Name:MCCORMAC, RUPERT JAMES IV (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:JAMES
Last Name:MCCORMAC
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 E BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2891
Mailing Address - Country:US
Mailing Address - Phone:800-805-6989
Mailing Address - Fax:864-877-1260
Practice Address - Street 1:2700 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4815
Practice Address - Country:US
Practice Address - Phone:864-235-2335
Practice Address - Fax:864-877-1260
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC218522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC218525Medicaid
SCH84946Medicare UPIN
SCC600610281Medicare ID - Type Unspecified