Provider Demographics
NPI:1689105371
Name:MCDERMOTT, KAILYN KUZMUK
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:KUZMUK
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAILYN
Other - Middle Name:MICHELE
Other - Last Name:KUZMUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3238
Mailing Address - Country:US
Mailing Address - Phone:781-444-7186
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3238
Practice Address - Country:US
Practice Address - Phone:781-444-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282519208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics