Provider Demographics
NPI:1396738076
Name:MCDERMOTT, CHRISTOPHER (MD)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
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 1:320 POMFRET ST
Mailing Address - Street 2:DKH PEDIATRIC CENTER
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-963-6390
Mailing Address - Fax:860-963-6343
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DKH PEDIATRIC CENTER
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-963-6390
Practice Address - Fax:860-963-6343
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060646599OtherUNITED HEATHCARE
CT060646599OtherEBPA / NORTHEAST HEALTH D
CT1187570OtherCIGNA
CT001404483CLMedicaid
CT060646599OtherNEHCA / HMC PPO
CT5412114OtherCCN
CT7988333OtherAETNA
CT060646599OtherPIONEER
CT060646599OtherPRIVATE HEALTHCARE SYSTEM
CT060646599OtherGREAT WEST
CT2V1888OtherHELATH NET
CT060646599OtherCOMMUNITY HEALTH NETWORK
CT2117234OtherFIRST HEALTH
CT010040448CT01OtherANTHEM BLUE CROSS
CT060646599OtherMULTIPLAN
CT201494OtherPREFERRED ONE/FIRST CHOIC
CT060646599001OtherHEALTH NET FEDERAL SERVIC
CT040448OtherCONNECTICARE
CT060646599OtherCIPA / CCC IPA
CTP2647031OtherOXFORD