Provider Demographics
NPI:1336156074
Name:MCCORMICK, JAMES T (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2566 HAYMAKER RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3555
Mailing Address - Country:US
Mailing Address - Phone:412-457-0040
Mailing Address - Fax:412-457-0050
Practice Address - Street 1:2566 HAYMAKER RD STE 304
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3555
Practice Address - Country:US
Practice Address - Phone:412-457-0040
Practice Address - Fax:412-457-0050
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010297L208C00000X, 2086S0129X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101364173Medicaid
11821840OtherCAQH