Basic Information
| Provider Information | |||||||||
| NPI: | 1427396399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2027 LEBANON CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | WEST MIFFLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151222461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126558650 | ||||||||
| FaxNumber: | 4126556409 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 LEBANON CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | WEST MIFFLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151222461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126558650 | ||||||||
| FaxNumber: | 4126556409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA055896 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.