MEDICARE: DR. DENNY CORMIER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101240779	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154513257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNY CORMIER M.D.

Provider Business Mailing Address
First Line	:	5007 VICTORY BLVD
Second Line	:
City	:	TABB
State	:	VA
Zip	:	23693
Country	:	US
Telephone Number	:	757-320-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 VICTORY BLVD
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-5606
Country	:	US
Telephone Number	:	757-320-4317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	12/21/2007

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