Healthcare Provider Details

I. General information

NPI: 1457417115
Provider Name (Legal Business Name): ANNE P MCCORMACK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6823 19TH AVE NE
SEATTLE WA
98115-6941
US

IV. Provider business mailing address

6823 19TH AVE NE
SEATTLE WA
98115-6941
US

V. Phone/Fax

Practice location:
  • Phone: 206-601-1876
  • Fax:
Mailing address:
  • Phone: 206-601-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD00032588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: