MEDICARE: DR. MICHAEL COOPER MCCORMICK D.D.S

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	1223G0001X	General Practice Dentistry	DS-030011L	PA

General Provider Information

NPI Number	:	1245279710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL COOPER MCCORMICK D.D.S

Provider Business Mailing Address
First Line	:	820 SUNSET CIR
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6786
Country	:	US
Telephone Number	:	724-453-0809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1928
Country	:	US
Telephone Number	:	724-658-1681
Fax Number	:	724-658-8851

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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