Healthcare Provider Details

I. General information

NPI: 1114244142
Provider Name (Legal Business Name): BRIAN WILLIAM MCDERMOTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BANCROFT PKWY STE 12
WILMINGTON DE
19805-2690
US

IV. Provider business mailing address

1010 N BANCROFT PKWY STE 12
WILMINGTON DE
19805-2690
US

V. Phone/Fax

Practice location:
  • Phone: 302-658-1129
  • Fax:
Mailing address:
  • Phone: 302-658-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1-0000227
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0000227
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: