Provider Demographics
NPI:1942378179
Name:MCCORMACK, LEAH S (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:S
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11020 73 ROAD
Mailing Address - Street 2:1G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6362
Mailing Address - Country:US
Mailing Address - Phone:718-261-4300
Mailing Address - Fax:718-268-3012
Practice Address - Street 1:11020 73 ROAD
Practice Address - Street 2:1G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6362
Practice Address - Country:US
Practice Address - Phone:718-261-4300
Practice Address - Fax:718-268-3012
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY157445207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
21D441OtherEMPIRE BCBS
0061681OtherGHI
21D441OtherEMPIRE BCBS