Provider Demographics
NPI:1831965979
Name:MCDERMOTT, EMILY REBECCA (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:61 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BERGEN
Mailing Address - State:NY
Mailing Address - Zip Code:14416-9536
Mailing Address - Country:US
Mailing Address - Phone:315-877-2152
Mailing Address - Fax:
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1025
Practice Address - Country:US
Practice Address - Phone:585-786-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant