Provider Demographics
NPI:1013119544
Name:MOIRA L MCDERMOTT LOWER CAPE PODIATRY
Entity Type:Organization
Organization Name:MOIRA L MCDERMOTT LOWER CAPE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-255-1100
Mailing Address - Street 1:4 GRANITE STATE CT
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2127
Mailing Address - Country:US
Mailing Address - Phone:508-255-1100
Mailing Address - Fax:
Practice Address - Street 1:4 GRANITE STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2127
Practice Address - Country:US
Practice Address - Phone:508-255-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA729636OtherTUFTS GROUP#
MAH670OtherHARVARD GROUP #
MAH679OtherHARVARD PILGRIM
MAY77135OtherBC GROUP#
MA1082400001Medicare NSC
MAY77135Medicare ID - Type UnspecifiedMEDICARE GROUP