Provider Demographics
NPI:1801898390
Name:MCCORMICK, GREGORY P (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:100 HIGHLAND ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3881
Mailing Address - Country:US
Mailing Address - Phone:617-696-0660
Mailing Address - Fax:617-696-6655
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 222
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-0660
Practice Address - Fax:617-696-6655
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ06515Medicare UPIN
MAAP2059Medicare ID - Type Unspecified