Provider Demographics
NPI:1720166119
Name:MCDERMOTT, DAVID WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:MCDERMOTT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1084 CARRIAGE HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6516
Mailing Address - Country:US
Mailing Address - Phone:210-823-5894
Mailing Address - Fax:
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:STE 130
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:410-266-8054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227842208600000X
MDD70881208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery