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General NPI Number Information
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NPI Number | 1891887543
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Entity Type | Individual
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Provider Name | PATRICIA C MCCORMACK M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1550 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1578
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Country | US
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Telephone | 718-698-9572
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Fax | 718-698-9573
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Provider Business Mailing Address
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Address Line | 1550 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1578
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Country | US
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Telephone | 718-698-9572
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Fax | 718-698-9573
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 161216
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MA04075800
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License Number State | NJ
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