Provider Demographics
NPI:1669780169
Name:MCCORMICK, DEIRDRE E (MPH)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:E
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1411
Mailing Address - Country:US
Mailing Address - Phone:516-507-7296
Mailing Address - Fax:
Practice Address - Street 1:90 VERNON AVE
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1411
Practice Address - Country:US
Practice Address - Phone:516-507-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program