Provider Demographics
NPI:1043772189
Name:MCDERMOTT, AMBER JO (DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JO
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1799
Mailing Address - Country:US
Mailing Address - Phone:330-363-4306
Mailing Address - Fax:330-580-5516
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1799
Practice Address - Country:US
Practice Address - Phone:330-363-4306
Practice Address - Fax:330-580-5516
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program