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General NPI Number Information
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NPI Number | 1154682292
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Entity Type | Individual
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Provider Name | MRS. CARRIE R MCDERMOTT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 1 PAM CT
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1158
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Country | US
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Telephone | 631-275-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PAM CT
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1158
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Country | US
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Telephone | 631-275-6570
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 514265111
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 363152911
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 563369112
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 516370112
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 516371112
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 563372112
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License Number State | NY
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Taxonomy #7
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1119438
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License Number State | NY
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