Basic Information
| Provider Information | |||||||||
| NPI: | 1396738076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDERMOTT | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 POMFRET ST | ||||||||
| Address2: | DKH PEDIATRIC CENTER | ||||||||
| City: | PUTNAM | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062601836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609636390 | ||||||||
| FaxNumber: | 8609636343 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 POMFRET ST | ||||||||
| Address2: | DKH PEDIATRIC CENTER | ||||||||
| City: | PUTNAM | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062601836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609636390 | ||||||||
| FaxNumber: | 8609636343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 07/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 040448 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 060646599 | 01 | CT | UNITED HEATHCARE | OTHER | 060646599 | 01 | CT | EBPA / NORTHEAST HEALTH D | OTHER | 1187570 | 01 | CT | CIGNA | OTHER | 001404483CL | 05 | CT | MEDICAID | 060646599 | 01 | CT | NEHCA / HMC PPO | OTHER | 5412114 | 01 | CT | CCN | OTHER | 7988333 | 01 | CT | AETNA | OTHER | 060646599 | 01 | CT | PIONEER | OTHER | 060646599 | 01 | CT | PRIVATE HEALTHCARE SYSTEM | OTHER | 060646599 | 01 | CT | GREAT WEST | OTHER | 2V1888 | 01 | CT | HELATH NET | OTHER | 060646599 | 01 | CT | COMMUNITY HEALTH NETWORK | OTHER | 2117234 | 01 | CT | FIRST HEALTH | OTHER | 010040448CT01 | 01 | CT | ANTHEM BLUE CROSS | OTHER | 060646599 | 01 | CT | MULTIPLAN | OTHER | 201494 | 01 | CT | PREFERRED ONE/FIRST CHOIC | OTHER | 060646599001 | 01 | CT | HEALTH NET FEDERAL SERVIC | OTHER | 040448 | 01 | CT | CONNECTICARE | OTHER | 060646599 | 01 | CT | CIPA / CCC IPA | OTHER | P2647031 | 01 | CT | OXFORD | OTHER |