Provider Demographics
NPI:1700827771
Name:MCCORMICK, DANIEL-JOSEPH TIMOTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL-JOSEPH
Middle Name:TIMOTHY
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5038
Mailing Address - Country:US
Mailing Address - Phone:610-872-9101
Mailing Address - Fax:610-872-9103
Practice Address - Street 1:2304 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5038
Practice Address - Country:US
Practice Address - Phone:610-872-9101
Practice Address - Fax:610-872-9103
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002136L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant