MEDICARE: DR. BRADLEY L MCCORMACK DDS

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	122300000X	Dentist	21626	OH

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	:	1215117866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY L MCCORMACK DDS

Provider Business Mailing Address
First Line	:	34155 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3221
Country	:	US
Telephone Number	:	440-327-7950
Fax Number	:	440-327-1825

Provider Business Practice Location Address
First Line	:	34155 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3221
Country	:	US
Telephone Number	:	440-327-7950
Fax Number	:	440-327-1825

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

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	07/18/2016

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