1396738076 NPI number — MR. CHRISTOPHER MCDERMOTT MD

Table of content: MR. CHRISTOPHER MCDERMOTT MD (NPI 1396738076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738076 NPI number — MR. CHRISTOPHER MCDERMOTT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
CHRISTOPHER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
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:
1396738076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 POMFRET ST
Provider Second Line Business Mailing Address:
DKH PEDIATRIC CENTER
Provider Business Mailing Address City Name:
PUTNAM
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06260-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-963-6390
Provider Business Mailing Address Fax Number:
860-963-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 POMFRET ST
Provider Second Line Business Practice Location Address:
DKH PEDIATRIC CENTER
Provider Business Practice Location Address City Name:
PUTNAM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06260-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-963-6390
Provider Business Practice Location Address Fax Number:
860-963-6343
Provider Enumeration Date:
08/26/2005

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: 208000000X , with the licence number:  040448 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060646599 . This is a "UNITED HEATHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "EBPA / NORTHEAST HEALTH D" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1187570 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001404483CL , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060646599 . This is a "NEHCA / HMC PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5412114 . This is a "CCN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7988333 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "PIONEER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "GREAT WEST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V1888 . This is a "HELATH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "COMMUNITY HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2117234 . This is a "FIRST HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010040448CT01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 201494 . This is a "PREFERRED ONE/FIRST CHOIC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599001 . This is a "HEALTH NET FEDERAL SERVIC" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 040448 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060646599 . This is a "CIPA / CCC IPA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2647031 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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