Provider Demographics
NPI:1720192594
Name:MCDERMOTT, FLORDELIZA MIRANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORDELIZA
Middle Name:MIRANDA
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 1:400 S WITCHDUCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3635
Mailing Address - Country:US
Mailing Address - Phone:757-490-8106
Mailing Address - Fax:757-490-8107
Practice Address - Street 1:400 S WITCHDUCK RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3635
Practice Address - Country:US
Practice Address - Phone:757-490-8106
Practice Address - Fax:757-490-8107
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist