Individual
TIMOTHY J MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1532 LONE OAK RD STE 415, PADUCAH, KY 42003
(270) 442-0103
(270) 442-0109
Mailing address
2200 JEFFERSON AVE FL 5, TOLEDO, OH 43604-7102
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
E7468
AR
207RC0000X
Cardiovascular Disease Physician
R3N07
MO
207RI0011X
Interventional Cardiology Physician
Primary
51912
KY
207RI0011X
Interventional Cardiology Physician
LT15153
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192825001
—
AR
05
—
1972613487
—
MO
05
—
202840617
—
MO
01
—
P01161167
RAILROAD MEDICARE
MO
Enumeration date
08/30/2006
Last updated
10/01/2018
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