Provider Demographics
NPI:1538165139
Name:MCCORMICK, CHAD D (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:849 N SYRINGA ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8794
Mailing Address - Country:US
Mailing Address - Phone:208-777-1320
Mailing Address - Fax:208-777-1322
Practice Address - Street 1:849 N SYRINGA ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8794
Practice Address - Country:US
Practice Address - Phone:208-777-1320
Practice Address - Fax:208-777-1322
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9014207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0083113OtherMEDICAID
WA8409260OtherMEDICAID
I16009Medicare UPIN
WA8409260OtherMEDICAID