Provider Demographics
NPI:1124040084
Name:DEMOTT, DEBORAH LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:DEMOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2320 WOOLSEY ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1973
Mailing Address - Country:US
Mailing Address - Phone:510-843-8002
Mailing Address - Fax:510-540-4808
Practice Address - Street 1:2320 WOOLSEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1973
Practice Address - Country:US
Practice Address - Phone:510-843-8002
Practice Address - Fax:510-540-4808
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G766390OtherMEDICAL
CAF96062Medicare UPIN