DR. KELLY EILEEN MCDERMOTT MD NPI 1619593258

NPI Information

  • NPI: 1619593258
  • Provider Name: DR. KELLY EILEEN MCDERMOTT, MD
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4921 PARKVIEW PL
    DIV IM GENERAL MED, STE 12B
    SAINT LOUIS, MO
    ZIP 63110
  • Phone: (314) 747-3969

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NPI Details

DR. Kelly Eileen Mcdermott, MD is a general practice in Saint Louis, MO with 5 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Kelly Eileen Mcdermott, MD NPI is 1619593258. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: EASTERN VIRGINIA MEDICAL SCHOOL
Graduation Year:2020

The provider's business location address is:

4921 PARKVIEW PL
DIV IM GENERAL MED, STE 12B
SAINT LOUIS, MO
ZIP 63110-032
Phone: (314) 747-3969
Fax: (314) 996-3230

The NPI 1619593258 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/19/2020 and was last updated on 4/25/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal Medicine2023001041MISSOURINo
2208D00000XGeneral Practice2023001041MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200085095MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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