Individual
CORMAC ODONOVAN
Active
Individual
CORMAC ODONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
9500678
NC
2084N0600X
Clinical Neurophysiology Physician
9500678
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11387
PARTNERS
NC
05
—
3002234000
—
WV
01
—
5249360
AETNA
—
05
—
6100368
—
VA
01
—
63701
BCBS
NC
01
—
64148
MEDCOST
NC
05
—
8963701
—
NC
05
—
Q00670
—
SC
Enumeration date
12/20/2005
Last updated
11/12/2010
Update your record
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