1972604379 NPI number — FRANCIS V MCDERMOTT III MD

Table of content: FRANCIS V MCDERMOTT III MD (NPI 1972604379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972604379 NPI number — FRANCIS V MCDERMOTT III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
FRANCIS
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1972604379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 COUNTY RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
IPSWICH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01938-2585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-356-5522
Provider Business Mailing Address Fax Number:
978-356-0218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 COUNTY RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
IPSWICH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01938-2585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-356-5522
Provider Business Practice Location Address Fax Number:
978-356-0218
Provider Enumeration Date:
09/26/2006

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: 207R00000X , with the licence number:  205131 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 205131 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110001951A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".