Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101233852 | VA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0101233852 | VA |
NPI | 1366489874 |
---|---|
Provider Name | Brian Mcdermott |
First Address | Fredericksburg, VA 22401-3000 |
Second Address | Fredericksburg, VA 22401-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 17/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H61918 | (02) |