1316056401 NPI number — DR. MOIRA MCDERMOTT D.P.M

Table of content: DR. MOIRA MCDERMOTT D.P.M (NPI 1316056401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316056401 NPI number — DR. MOIRA MCDERMOTT D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
MOIRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316056401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 GRANITE STATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02631-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-255-1100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 GRANITE STATE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02631-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-255-1100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1654 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2537683 . This is a "AETNA - HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y77135 . This is a "BCBS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 33188 . This is a "HARVARD PILGRIM #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y70727 . This is a "BCBS INDIVIDUAL #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1524756 . This is a "UNITED HEALTHCARE GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9764542 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2021485 . This is a "UNITED HEALTHCARE SOLO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4529854 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 001654 . This is a "TUFTS #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1168933 . This is a "UNITED HEALTHCARE SOLO 2" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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