MEDICARE: DR. MARIE C MCCORMICK MD, DSC

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	58490	MA

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	:	1831108109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE C MCCORMICK MD, DSC

Provider Business Mailing Address
First Line	:	478 QUINOBEQUIN RD
Second Line	:
City	:	WABAN
State	:	MA
Zip	:	02468-2127
Country	:	US
Telephone Number	:	617-965-8279
Fax Number	:

Provider Business Practice Location Address
First Line	:	677 HUNTINGTON AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-6028
Country	:	US
Telephone Number	:	617-432-3759
Fax Number	:	617-432-3755

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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