Provider Demographics
NPI:1952586166
Name:MCDERMOTT, WILLIAM ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3201
Mailing Address - Country:US
Mailing Address - Phone:410-939-1111
Mailing Address - Fax:410-939-3552
Practice Address - Street 1:319 S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3201
Practice Address - Country:US
Practice Address - Phone:410-939-1111
Practice Address - Fax:410-939-3552
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD674QMedicare PIN