Provider Demographics
NPI:1952444796
Name:MCCORMICK, THOMAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:40 S BANK ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1322
Practice Address - Country:US
Practice Address - Phone:859-498-2815
Practice Address - Fax:859-498-5669
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
611202293OtherFEDERAL TAX NUMBER
KY64268618Medicaid
611202293OtherFEDERAL TAX NUMBER
KYK051761Medicare PIN