Provider Demographics
NPI:1790560316
Name:MCCORD, CHRISTOPHER JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:MCCORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CURREY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2852
Mailing Address - Country:US
Mailing Address - Phone:631-901-6304
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2290
Practice Address - Country:US
Practice Address - Phone:631-283-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030599207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery