Individual
CORMAC ODONOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-9016
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-9016
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
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