Provider Demographics
NPI:1174738157
Name:MCDERMOTT, DIANA TAMAR (MD, MPH)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:TAMAR
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50842
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70150-0842
Mailing Address - Country:US
Mailing Address - Phone:504-312-1790
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR
Practice Address - Street 2:STE 1300
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1668
Practice Address - Country:US
Practice Address - Phone:504-575-3712
Practice Address - Fax:504-575-3691
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA199909207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1065447Medicaid
LA1065447Medicaid
LA4K592F669Medicare PIN