Provider Demographics
NPI:1336112424
Name:MCDERMOTT, GAYLE PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:PATRICIA
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 1:423 E 23 STREET
Mailing Address - Street 2:PRIMARY CARE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:
Practice Address - Street 1:423 E 23 STREET
Practice Address - Street 2:PRIMARY CARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95772207R00000X
NJ25MA08734900207R00000X
NY255647-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A957720OtherBLUE CROSS BLUE SHIELD OF CALIFORNIA
CAP00468685OtherRR MEDICARE, SAN FRANCISCO RAILROAD MEDICARE
CA00A957720Medicaid
CA00A957720Medicare PIN
CA00A957720Medicaid