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General NPI Number Information
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NPI Number | 1518090976
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Entity Type | Organization
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Legal Business Name | EDWARD MCDERMOTT MD
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 276 MONTAUK AVE # R
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City | NEW LONDON
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State | CT
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Zip | 06320-4727
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Country | US
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Telephone | 860-442-0930
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Fax | 860-447-8598
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Provider Business Mailing Address
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Address Line | 276 MONTAUK AVE # R
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City | NEW LONDON
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State | CT
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Zip | 06320-4727
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Country | US
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Telephone | 860-442-0930
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Fax | 860-447-8598
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD MCDERMOTT
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Credential | MD
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Telephone | 860-442-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | B84483
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License Number State | CT
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