Provider Demographics
NPI:1487780151
Name:MCCORMACK, SHANA ERIN (MD)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:ERIN
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA - ENDOCRINOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3174
Practice Address - Fax:215-590-3053
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAL-224522208000000X
PAMD4454892080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics