Provider Demographics
NPI:1124111844
Name:MCCORKLE, DOUGLAS C (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-363-7172
Mailing Address - Fax:410-363-7188
Practice Address - Street 1:10 CROSSROADS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-7172
Practice Address - Fax:410-363-7188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033742207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3383624OtherUS HEALTHCARE
MD31779OtherALLIANCE
MD31779OtherMAMSI
MD44425OtherINJURED WORKERS INS FUND
MD42461004OtherBLUECROSS BLUESHEILD
MDKFN6DOOtherBLUECROSSBLUESHIELD
MD1000254OtherUNITED HEALTHCARE
MD31779OtherMDI PA
MD4137034OtherAETNA
MDJ1140001OtherBCBS FEDERAL
MDJ1140001OtherBLUECHOICE
MD31779OtherOPTIMUM CHOICE
MD44425OtherINJURED WORKERS INS FUND
MDE16585Medicare UPIN