Provider Demographics
NPI:1154393569
Name:MCCORVEY, DAVID LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:MCCORVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:130 CENTERWAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-936-9971
Practice Address - Fax:607-936-2600
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4243452086S0122X
NY232184-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
NYP00196065OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PAGU039880OtherPA MEDICARE GROUP
PAP00198743OtherRR MEDICARE PIN
NY02576121Medicaid
PA1010463660001Medicaid
NY02576121Medicaid
NYCC8362OtherRR MEDICARE GROUP
PA081377N9FMedicare ID - Type Unspecified