Basic Information
| Provider Information | |||||||||
| NPI: | 1548502354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 CASTLE PINE LN | ||||||||
| Address2: | |||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253098532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043434691 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 CASTLE PINE LN | ||||||||
| Address2: | |||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043434691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 25202 | WV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.