Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 2019-02942 | NC |
N | 207RH0003X | Hematology & Oncology | MD464687 | PA |
NPI | 1003179045 |
---|---|
Provider Name | Dr. Michael Joseph Mccormack JR. |
First Address | Winston Salem, NC 27157-0001 |
Second Address | Winston Salem, NC 27157-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 18/10/2021 |