Provider Demographics
NPI:1942329248
Name:ALICE MC CORMICK DO PC
Entity Type:Organization
Organization Name:ALICE MC CORMICK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-969-0663
Mailing Address - Street 1:3 W OLIVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-969-0663
Mailing Address - Fax:570-969-9697
Practice Address - Street 1:1565 ROUTE 507
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4503
Practice Address - Country:US
Practice Address - Phone:570-676-4276
Practice Address - Fax:570-969-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004730L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010358980008Medicaid
PA419188Medicare ID - Type Unspecified
PAC33768Medicare UPIN