DERMOT M MCDERMOTT (NPI# 1457352437) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457352437 |
| Entity Type | Individual |
| Full Name | DERMOT M MCDERMOTT |
| Credential | PA-C |
| Practice Address |
874 Howard Ave New Haven CT 06519-1106 |
| Practice Telephone | 2036888200 |
| Practice Fax Number | 2036888204 |
| Mailing Telephone | 2036888200 |
| Mailing Fax Number | 2036888204 |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2009-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
000997 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | CONNECTICARE | 000997 | 01 |
| CT | OXFORD | P2531898 | 01 |
| CT | HELATH NET | 0Q2937 | 01 |
| CT | ANTHEM BC/BS | 290000997CT01 | 01 |
| CT | WELLCARE OF CT | 369530 | 01 |
| CT | RAIL ROAD MEDICARE | 970019423 | 01 |
| CT | UNITED HEALTHCARE | 061561581 | 01 |
| Street Address |
874 HOWARD AVE |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730667270 | Michael Riley Levien | Nurse Practitioner | 874 Howard Ave, New Haven, CT 06519-1106 | 2018-08-06 |
| 1922463835 | Thao T Nguyen | Nurse Practitioner | 874 Howard Ave, Basement - Room 007, New Haven, CT 06519-1106 | 2015-12-18 |
| 1982072591 | Shannon P Kukulka | Nurse Practitioner | 874 Howard Ave, New Haven, CT 06519-1106 | 2015-09-14 |
| 1053679431 | Alessandra Capobianco | Internal Medicine | 874 Howard Ave, Nemg - Ynh Geriatric Services, New Haven, CT 06519-1106 | 2012-04-24 |
| 1851666085 | Gregory Michael Ouellet | Internal Medicine | 874 Howard Ave, New Haven, CT 06519 | 2012-03-21 |
| 1598080384 | Hsiao-ying Chin | Internal Medicine | 874 Howard Ave, Basement - Room 007, New Haven, CT 06519-1106 | 2010-04-05 |
| 1891019675 | Mill Hill Medical Consultants Inc | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2010-03-23 |
| 1043544596 | Susann Varano I | Internal Medicine | 874 Howard Ave, Basement, Room 007, New Haven, CT 06519-1106 | 2009-09-30 |
| 1164658233 | Marcia Cathleen Mecca | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2009-06-03 |
| 1972740124 | Ronald L. Miller | Internal Medicine | 874 Howard Ave, New Haven, CT 06519-1106 | 2009-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1780123414 | Claire Louise Hardin | General Acute Care Hospital | 95 Howard Ave, New Haven, CT 06519 | 2017-02-14 |
| 1467809137 | Ana Laura Vives-rodriguez | Student in an Organized Health Care Education/Training Program | 800 Howard Avenue, Lower Level, Yale Physicians Building, New Haven, CT 06519 | 2016-05-23 |
| 1346607785 | Amanda Kayte Corcoran | Advanced Practice Midwife | 40 Prince St., Suite 207, New Haven, CT 06519 | 2016-01-15 |
| 1720491905 | Sara Harcharik Perkins | Dermatology | 2 Church St S Ste 305, New Haven, CT 06519 | 2014-06-05 |
| 1194136713 | Krishan Ratilal Jethwa | Radiology | 35 Park St Ste Ll507, New Haven, CT 06519 | 2014-05-16 |
| 1235549353 | Brandon Michael Kitay | Psychiatry & Neurology | 184 Liberty St # Lv108, New Haven, CT 06519 | 2014-04-28 |
| 1649526617 | Yale New Haven Hospital | Student in an Organized Health Care Education/Training Program | 330 Cedar St Fmb 107, Yale New Haven Hospital, Dept of Surgery, New Haven, CT 06519 | 2012-07-27 |
| 1669736765 | Mayanka Tickoo | Internal Medicine | 300 Cedar St Fl 4, New Haven, CT 06519 | 2012-07-03 |
| 1730441627 | Judith A Ross | Physical Therapist | 18 Tower Lane, Tower One Tower East, New Haven, CT 06519 | 2012-06-15 |
| Find all providers in zip 06519 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790319655 | Erin Kelly Flynn | Physician Assistant | 464 Congress Ave # Suie260, New Haven, CT 06519-1361 | 2020-02-28 |
| 1659919702 | Jeniece Kayla Wert | Physician Assistant | 100 Church Street South, Suite A230 Room A235, New Haven, CT 06519-1703 | 2019-12-18 |
| 1588121354 | Jason Michael Nies | Physician Assistant | 20 York St # 218, New Haven, CT 06510-3220 | 2019-02-27 |
| 1902334436 | Lauren Veronica Boggs | Physician Assistant | 45 Ley St, New Haven, CT 06512-3921 | 2017-05-29 |
| 1831353853 | Dina Weiner | Physician Assistant | 840 Howard Ave Fl 1, New Haven, CT 06519-1106 | 2008-07-18 |
| 1528244027 | Gerald Kayingo | Physician Assistant | 211 Fountain St, Apt 12, New Haven, CT 06515-1979 | 2008-01-14 |
| 1821219783 | Susanne Atkins | Physician Assistant | 175 Sherman Avenue, New Haven, CT 06511 | 2007-05-01 |
| 1023133626 | John Sceppa | Physician Assistant | Yale -new Haven Hospital, 20 York St., New Haven, CT 06510-3202 | 2007-03-20 |
| 1922147578 | Janice Decho | Physician Assistant | 20 York St Cb- 2041, New Haven, CT 06504-8900 | 2007-02-06 |
| 1578613964 | Brian Patrick Munday | Physician Assistant | 800 Howard Ave Lower Level, Comprehensive Epilepsy Center LLCi 716, New Haven, CT 06520-8018 | 2007-01-10 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.