MEDICARE: ANNMARIE MCDERMOTT M.D.

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	207V00000X	Obstetrics & Gynecology Physician	MD065886L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	684343	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1821090218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNMARIE MCDERMOTT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	1611 POND RD STE 300
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-2258
Country	:	US
Telephone Number	:	610-398-7700
Fax Number	:	610-398-6917

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/23/2020

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