Active NPI
Candace A MC Cormick, M.D.
- Anesthesiology Physician
- Charleston, WV
National Provider Identifier
1497755862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 13216
- Practice address
- 3508 Staunton Ave SE
Charleston, WV 25304-1477 - Phone
- (304) 925-4086
- NPI assigned
- Jul 28, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 13216 | WV | Primary |
Addresses
Primary practice location
3508 Staunton Ave SE
Charleston, WV 25304-1477
Mailing address
PO Box 3444
Charleston, WV 25334-3444
Phone (304) 925-5486
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0057871000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1497755862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3444",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253343444",
"telephone_number": "304-925-5486",
"fax_number": "304-925-8075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3508 STAUNTON AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041477",
"telephone_number": "304-925-4086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MC CORMICK",
"first_name": "CANDACE",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-28",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WV",
"license": "13216",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0057871000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.