Healthcare Provider Details

I. General information

NPI: 1831765148
Provider Name (Legal Business Name): LINDSAY MCCORMACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WILLIAM ST STE G15
WELLESLEY MA
02481-4102
US

IV. Provider business mailing address

20 WILLIAM ST STE G15
WELLESLEY MA
02481-4102
US

V. Phone/Fax

Practice location:
  • Phone: 781-591-4234
  • Fax: 781-369-9737
Mailing address:
  • Phone: 781-591-4234
  • Fax: 781-369-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1023677
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: