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General NPI Number Information
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NPI Number | 1629109467
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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 | 03/07/2007
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 276R MONTAUK AVE
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City | NEW LONDON
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State | CT
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Zip | 06320
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Country | US
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Telephone | 860-447-1475
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Fax | 860-447-8598
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Provider Business Mailing Address
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Address Line | 276R MONTAUK AVE
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City | NEW LONDON
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State | CT
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Zip | 06320
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Country | US
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Telephone | 860-447-1475
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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 J MCDERMOTT
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Credential | MD
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Telephone | 860-447-1475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20822
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License Number State | CT
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