Provider Demographics
NPI:1710959010
Name:MCCORKILL, WALTER MERRILLE (IDC USN)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:MERRILLE
Last Name:MCCORKILL
Suffix:
Gender:M
Credentials:IDC USN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 WOODSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-9505
Mailing Address - Country:US
Mailing Address - Phone:757-546-3267
Mailing Address - Fax:
Practice Address - Street 1:RIVERINE GROUP ONE
Practice Address - Street 2:ATTN BLDG 2012 240 AMPHIBIOUS DR STE 125
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2843
Practice Address - Country:US
Practice Address - Phone:757-462-2017
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman