Individual
DR. EDWARD J MCDERMOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
235 LESTERTOWN RD, GROTON, CT 06340-2808
(860) 445-7478
Mailing address
342 MONTAUK AVE, NEW LONDON, CT 06320-4726
(860) 460-3236
(860) 442-7270
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
20822
CT
207R00000X
Internal Medicine Physician
Primary
20822
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001208222
—
CT
01
—
010020822CT03
ANTHEM BLUE CROSS
CT
01
—
030963
HEALTH NET
CT
Enumeration date
11/28/2005
Last updated
05/06/2019
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