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General NPI Number Information
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NPI Number | 1033496567
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Entity Type | Individual
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Provider Name | MEGHAN KELLY MCCORMICK D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-356-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2787 MAPLE AVE
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-2435
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Country | US
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Telephone | 516-479-4285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 58004726
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.012023
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License Number State | OH
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