Provider Demographics
NPI:1750609830
Name:MCCORMICK, ALEX TAYLOR (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:TAYLOR
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23175 COMMERCE PARK STE B
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5806
Mailing Address - Country:US
Mailing Address - Phone:440-252-1475
Mailing Address - Fax:
Practice Address - Street 1:23175 COMMERCE PARK STE B
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5806
Practice Address - Country:US
Practice Address - Phone:440-252-1475
Practice Address - Fax:440-252-3455
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0112912084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106010Medicaid
OH0106010Medicaid