Provider Demographics
NPI:1972566644
Name:MCCORMICK, JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24 SALT POND RD
Mailing Address - Street 2:UNIT E1
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4314
Mailing Address - Country:US
Mailing Address - Phone:401-783-2424
Mailing Address - Fax:401-789-2095
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:UNIT E1
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-783-2424
Practice Address - Fax:401-789-2095
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00281213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
400540OtherBLUE CHIP GROUP NUMBER
9146868001OtherCIGNA GROUP NUMBER
RI400540OtherBLUE CHIP RI
RIPT SSN #OtherTRI CARE
RI0000031649OtherBCBC OF RI
RI1358850OtherAETNA HMO
RI204928511OtherUNITED HEALTH CARE
480020466OtherGENERIC7
RIAA69500OtherHARVARD PILGRIM
1164100001OtherGENERIC6
580173OtherGENERIC3 GROUP NUMBER
583173OtherGENERIC3
RI7008235Medicaid
RI164100001OtherRAILROAD MEDICARE
RI5807131OtherAETNA COMMERCIAL
0000007213OtherGENERIC4 GROUP NUMBER
9146868001OtherCIGNA
2944OtherNEIGHBORHOOD HEALTH PLANS
RI1358850OtherAETNA HMO
RIAA69500OtherHARVARD PILGRIM