Provider Demographics
NPI:1750352100
Name:MCDERMOTT, CORNELIUS J (DO)
Entity type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:J
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 N. HAYDEN RD
Mailing Address - Street 2:#123-407
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-947-1130
Mailing Address - Fax:480-947-1132
Practice Address - Street 1:3370 N. HAYDEN RD
Practice Address - Street 2:#123-407
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-947-1130
Practice Address - Fax:480-947-1132
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3754207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569204Medicaid
106596Medicare ID - Type Unspecified
E67004Medicare UPIN