Healthcare Provider Details

I. General information

NPI: 1104755024
Provider Name (Legal Business Name): SARA MCCORMACK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 PIERCE ST
KINGSTON PA
18704-5716
US

IV. Provider business mailing address

1515 MONROE AVE
DUNMORE PA
18509-2443
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-2161
  • Fax:
Mailing address:
  • Phone: 570-862-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: