Provider Demographics
NPI:1457107617
Name:MCDERMOTT, LEONARD GIRARD JR
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:GIRARD
Last Name:MCDERMOTT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CROCKER ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2008
Mailing Address - Country:US
Mailing Address - Phone:440-320-1729
Mailing Address - Fax:
Practice Address - Street 1:260 CROCKER ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2008
Practice Address - Country:US
Practice Address - Phone:440-320-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRQ025191374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide