Provider Demographics
NPI:1093158818
Name:MCDERMOTT, MACI (MD,)
Entity Type:Individual
Prefix:DR
First Name:MACI
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 MACLAY BLVD.
Mailing Address - Street 2:STE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312
Mailing Address - Country:US
Mailing Address - Phone:850-877-1162
Mailing Address - Fax:850-671-5009
Practice Address - Street 1:3606 MACLAY BLVD
Practice Address - Street 2:STE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312
Practice Address - Country:US
Practice Address - Phone:850-877-1162
Practice Address - Fax:850-671-5009
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics