MEDICARE: LISA B MCDERMOTT MS, RD, CDE, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DN001473	PA

General Provider Information

NPI Number	:	1053821645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B MCDERMOTT MS, RD, CDE, LDN

Provider Business Mailing Address
First Line	:	575 COAL VALLEY RD STE 365
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3739
Country	:	US
Telephone Number	:	412-469-7915
Fax Number	:	412-469-7916

Provider Business Practice Location Address
First Line	:	575 COAL VALLEY RD STE 365
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3739
Country	:	US
Telephone Number	:	412-469-7915
Fax Number	:	412-469-7916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/08/2020

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