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General NPI Number Information
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NPI Number | 1053705335
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Entity Type | Individual
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Provider Name | ALLYSON MICHELLE MCDERMOTT M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-545-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 27 WATERSIDE LN
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City | WEST HARTFORD
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State | CT
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Zip | 06107-3523
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Country | US
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Telephone | 516-567-4942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 136148
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 60562
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License Number State | CT
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