Healthcare Provider Details

I. General information

NPI: 1972566644
Provider Name (Legal Business Name): JAMES MCCORMICK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD UNIT E1
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

24 SALT POND RD UNIT E1
WAKEFIELD RI
02879-4314
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-2424
  • Fax: 401-789-2095
Mailing address:
  • Phone: 401-783-2424
  • Fax: 401-789-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM00281
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: