1417917311 NPI number — DR. CAROLYN BRUMM MCCORMICK MD

Table of content: DR. CAROLYN BRUMM MCCORMICK MD (NPI 1417917311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417917311 NPI number — DR. CAROLYN BRUMM MCCORMICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCORMICK
Provider First Name:
CAROLYN
Provider Middle Name:
BRUMM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417917311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2914 N ELM ST
Provider Second Line Business Mailing Address:
PBM # 121
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28358-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-674-4392
Provider Business Mailing Address Fax Number:
866-295-6481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4308 LUDGATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-674-4392
Provider Business Practice Location Address Fax Number:
866-295-6481
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20317 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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