MEDICARE: JOHN C MCDERMOTT MD

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	2085R0204X	Vascular & Interventional Radiology Physician	23150	WI

General Provider Information

NPI Number	:	1235107061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C MCDERMOTT MD

Provider Business Mailing Address
First Line	:	2130 UNIVERSITY AVE APT 118
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53726-2354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 UNIVERSITY AVE APT 118
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53726-2354
Country	:	US
Telephone Number	:	--
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/25/2021

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