Provider Demographics
NPI:1306990031
Name:MCCORRY, JAMES W (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:MCCORRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 PARKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-7696
Mailing Address - Country:US
Mailing Address - Phone:757-258-5050
Mailing Address - Fax:757-258-3668
Practice Address - Street 1:7101 JANKE ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225
Practice Address - Country:US
Practice Address - Phone:804-330-2000
Practice Address - Fax:804-323-8049
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037185207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005829372Medicaid
VA005836441Medicaid
VA005836409Medicaid
VA256452OtherBLUE CROSS BLUE SHIELD
VA930002190Medicare ID - Type Unspecified
VA930001708Medicare ID - Type Unspecified
F14026Medicare UPIN
VA023083V01Medicare PIN
VA930001581Medicare PIN
VA930001709Medicare ID - Type Unspecified
VA256452OtherBLUE CROSS BLUE SHIELD
VA005836441Medicaid
VA005829372Medicaid