Provider Demographics
NPI:1942307046
Name:ALICE MCCORMICK, D.O., P.C.
Entity Type:Organization
Organization Name:ALICE MCCORMICK, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-676-4000
Mailing Address - Street 1:1565 ROUTE 507
Mailing Address - Street 2:KEYSTONE COMPLEX
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4503
Mailing Address - Country:US
Mailing Address - Phone:570-676-4000
Mailing Address - Fax:570-676-4060
Practice Address - Street 1:1565 ROUTE 507
Practice Address - Street 2:KEYSTONE COMPLEX
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4503
Practice Address - Country:US
Practice Address - Phone:570-676-4000
Practice Address - Fax:570-676-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty