Provider Demographics
NPI:1386721553
Name:MCCORMACK, FAITH J (MD)
Entity type:Individual
Prefix:DR
First Name:FAITH
Middle Name:J
Last Name:MCCORMACK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3012 SUMMIT ST
Mailing Address - Street 2:2ND FLOOR, THE PERMANENTE MEDICAL GROUP, INC
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3480
Mailing Address - Country:US
Mailing Address - Phone:510-869-8660
Mailing Address - Fax:510-869-8661
Practice Address - Street 1:3012 SUMMIT ST
Practice Address - Street 2:2ND FLOOR, THE PERMANENTE MEDICAL GROUP, INC
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3480
Practice Address - Country:US
Practice Address - Phone:510-869-8660
Practice Address - Fax:510-869-8661
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
CAG85525207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G855250Medicaid
CA00G855250OtherPPIN
CA00G855250OtherPPIN