Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 246127 | MA |
NPI | 1588823421 |
---|---|
Provider Name | Dr. Cormac Dermitt Depan |
First Address | Worcester, MA 01608-1216 |
Second Address | Worcester, MA 01608-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 06/07/2011 |