Provider Demographics
NPI:1790899508
Name:MCDERMOTT, RONALD IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:IAN
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 WREN RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2312
Mailing Address - Country:US
Mailing Address - Phone:615-851-8959
Mailing Address - Fax:615-851-5949
Practice Address - Street 1:824 WREN RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2312
Practice Address - Country:US
Practice Address - Phone:615-851-8959
Practice Address - Fax:615-851-5949
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7197644OtherAETNA
9842836002OtherCIGNA
3736131OtherMEDICARE GROUP PRICING NO
SSNOtherTRICARE
TN0101OtherAMERICHOICE
TN3818316Medicaid
4152576OtherBCBS
205724681OtherUNITED HEALTHCARE
G58444OtherHEALTHSPRING
01035857OtherAMERIGROUP
TN0101OtherAMERICHOICE
4152576OtherBCBS
G58444OtherHEALTHSPRING