Provider Demographics
NPI:1730117953
Name:MCCORMICK, ELLEN LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:LORRAINE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:#300
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-655-1685
Mailing Address - Fax:303-655-1703
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:#300
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-655-1685
Practice Address - Fax:303-655-1703
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27113208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01271139Medicaid
CO01271139Medicaid