Individual
MIRJAM MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
528 WASHINGTON HWY, MORRISVILLE, VT 05661-8973
(802) 888-8888
Mailing address
528 WASHINGTON HWY, MORRISVILLE, VT 05661-8973
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0420010794
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068350
BLUE CROSS
VT
05
—
1011031
—
VT
Enumeration date
07/22/2006
Last updated
07/08/2007
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