Provider Demographics
NPI:1679812721
Name:MCCORMICK, RODGER J (DED, MS)
Entity type:Individual
Prefix:DR
First Name:RODGER
Middle Name:J
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:46 N TENNEY DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8538
Mailing Address - Country:US
Mailing Address - Phone:304-472-0318
Mailing Address - Fax:
Practice Address - Street 1:46 N TENNEY DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8538
Practice Address - Country:US
Practice Address - Phone:304-472-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-10
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology
No1744R1102XOther Service ProvidersSpecialistResearch Study
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology