Provider Demographics
NPI:1316056401
Name:MCDERMOTT, MOIRA (DPM)
Entity type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GRANITE STATE CT
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2127
Mailing Address - Country:US
Mailing Address - Phone:508-255-1100
Mailing Address - Fax:
Practice Address - Street 1:4 GRANITE STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2127
Practice Address - Country:US
Practice Address - Phone:508-255-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1654213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2537683OtherAETNA - HMO
MAY77135OtherBCBS GROUP #
MA33188OtherHARVARD PILGRIM #
MAY70727OtherBCBS INDIVIDUAL #
MA1524756OtherUNITED HEALTHCARE GROUP
MA9764542Medicaid
MA2021485OtherUNITED HEALTHCARE SOLO
MA4529854OtherAETNA
MA001654OtherTUFTS #
MA1168933OtherUNITED HEALTHCARE SOLO 2
MAY70727Medicare ID - Type UnspecifiedMEDICARE SOLO NUMBER
MA33188OtherHARVARD PILGRIM #
MA1168933OtherUNITED HEALTHCARE SOLO 2