Basic Information
| Provider Information | |||||||||
| NPI: | 1841297629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDERMOTT | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 10TH ST SE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633600 | ||||||||
| FaxNumber: | 3193639971 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 10TH ST SE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633600 | ||||||||
| FaxNumber: | 3193639971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 31322 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0137885 | 05 | IA | MEDICAID | 54503 | 01 | IA | WELLMARK BL CROSS BL SH | OTHER |