Provider Demographics
NPI:1952030595
Name:MCCORQUODALE, JAMES FRANCIS
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:MCCORQUODALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SQUIRE LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3382
Mailing Address - Country:US
Mailing Address - Phone:401-867-1300
Mailing Address - Fax:
Practice Address - Street 1:44 SQUIRE LN UNIT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3382
Practice Address - Country:US
Practice Address - Phone:401-867-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO155874246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1487607784OtherTAX ID