Provider Demographics
NPI:1932162948
Name:MCCORMICK, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1125
Mailing Address - Country:US
Mailing Address - Phone:304-343-9923
Mailing Address - Fax:304-343-9925
Practice Address - Street 1:2930 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1125
Practice Address - Country:US
Practice Address - Phone:304-343-9923
Practice Address - Fax:304-343-9925
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13157207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0085391001Medicaid
WVA72211Medicare UPIN
WV0085391001Medicaid
P00996813Medicare PIN
WV0085391001Medicaid