Provider Demographics
NPI:1326085432
Name:MACDERMOTT, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MACDERMOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MALCOLM GROW MEDICAL CENTER
Mailing Address - Street 2:CARDIOPULMONARY DEPARTMENT/SGOMP
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-857-8283
Mailing Address - Fax:
Practice Address - Street 1:MALCOLM GROW MEDICAL CENTER
Practice Address - Street 2:CARDIOPULMONARY DEPARTMENT/SGOMP
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-857-8283
Practice Address - Fax:240-857-4354
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine