Provider Demographics
NPI:1013902899
Name:MCCORMACK, SHARON JAN (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JAN
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 OLD FREDERICK RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2195
Mailing Address - Country:US
Mailing Address - Phone:410-788-4800
Mailing Address - Fax:410-788-6701
Practice Address - Street 1:5411 OLD FREDERICK RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2195
Practice Address - Country:US
Practice Address - Phone:410-788-4800
Practice Address - Fax:410-788-6701
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038762207R00000X, 207RG0300X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
241559OtherOPTIMUM CHOICE MEDICINE
555691OtherAETNA
R8280004OtherCAREFIRST BCBS FEDERAL DC
1442421OtherUNITED HEALTHCARE
341559OtherOPTIMUM CHOICE ONCOLOGY
441559OtherOPTIMUM CHOICE HEMATOLOGY
MD52989302OtherCAREFIRST BCBS
0401662OtherUNITED HEALTHCARE AMERICH
MD52989302OtherCAREFIRST BCBS
R8280004OtherCAREFIRST BCBS FEDERAL DC