Provider Demographics
NPI:1194762666
Name:MCCORMICK, JAMES S (LAC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:S
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26 PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2210
Mailing Address - Country:US
Mailing Address - Phone:508-358-6366
Mailing Address - Fax:
Practice Address - Street 1:335 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1803
Practice Address - Country:US
Practice Address - Phone:617-354-8360
Practice Address - Fax:617-354-8361
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist