Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 5223923-1205 | UT |
N | 2080P0204X | Pediatric Emergency Doctor | 5223923-1205 | UT |
NPI | 1164452637 |
---|---|
Provider Name | Dr. Marc S Mcdermott |
First Address | North Adams, MA 01247-2538 |
Second Address | North Adams, MA 01247-2538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 09/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0142817 | (05) | MT |
100503184 | (05) | NV |
121348200 | (05) | WY |
806860000 | (05) | ID |
D5339 | (05) | UT |
H99716 | (02) | UT |