MEDICARE: THOMAS M MCCORMACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	210406	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508821596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M MCCORMACK MD

Provider Business Mailing Address
First Line	:	1182 TROY SCHENECTADY RD
Second Line	:	SUITE 100
City	:	LATHAM
State	:	NY
Zip	:	12110-1000
Country	:	US
Telephone Number	:	518-713-5400
Fax Number	:	518-713-5401

Provider Business Practice Location Address
First Line	:	1182 TROY SCHENECTADY RD
Second Line	:	SUITE 100
City	:	LATHAM
State	:	NY
Zip	:	12110-1000
Country	:	US
Telephone Number	:	518-713-5400
Fax Number	:	518-713-5401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	05/21/2021

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