Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP0504X | Public Medicine | 244128 | KY |
N | 213EP1101X | Primary Podiatric Medicine | 244128 | KY |
N | 111NR0200X | Radiology | 244128 | KY |
N | 213ER0200X | Radiology | 244128 | KY |
N | 2081S0010X | Sports Medicine | 244128 | KY |
N | 213ES0000X | Sports Medicine | 244128 | KY |
N | 213ES0103X | Foot & Ankle Surgery | 0585 | AZ |
Y | 213ES0103X | Foot & Ankle Surgery | 244128 | KY |
N | 213ES0103X | Foot & Ankle Surgery | 270 | KY |
N | 213ES0131X | Foot Surgery | 244128 | KY |
N | 213ES0131X | Foot Surgery | KY00270 | KY |
NPI | 1942284377 |
---|---|
Provider Name | Dr. Anthony P Demaria |
First Address | Crestview Hills, KY 41017-3931 |
Second Address | Crestview Hills, KY 41017-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000926847 | ANTHEM (01) | |
201301300 | (05) | IN |
7100106670 | (05) | KY |
793233 | (05) | AZ |
P01459301 | RAILROAD MEDICARE (01) | KY |
U96086 | (02) |