Provider Demographics
NPI:1609132273
Name:MCDERMOTT, DANA (D O)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23845 HOLMAN HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5907
Mailing Address - Country:US
Mailing Address - Phone:831-620-0700
Mailing Address - Fax:831-886-3649
Practice Address - Street 1:23845 HOLMAN HWY STE 210
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-620-0700
Practice Address - Fax:831-886-3649
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A129882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program