MEDICARE: DR. ELLEN LORRAINE MCCORMICK 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	208000000X	Pediatrics Physician	27113	CO

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	:	1730117953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN LORRAINE MCCORMICK M.D.

Provider Business Mailing Address
First Line	:	1606 PRAIRIE CENTER PKWY
Second Line	:	#300
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4004
Country	:	US
Telephone Number	:	303-655-1685
Fax Number	:	303-655-1703

Provider Business Practice Location Address
First Line	:	1606 PRAIRIE CENTER PKWY
Second Line	:	#300
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4004
Country	:	US
Telephone Number	:	303-655-1685
Fax Number	:	303-655-1703

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	04/26/2015

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