Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD042141E | PA |
Y | 207Q00000X | Family Doctor | MD042141-E | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD042141E | PA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD042141E | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD042141E | PA |
N | 207R00000X | Internist | MD042141E | PA |
N | 111NI0900X | Internist | MD042141E | PA |
N | 208D00000X | General Practice Physician | MD042141E | PA |
NPI | 1659313419 |
---|---|
Provider Name | Dr. William Joseph Demedio |
First Address | Springfield, PA 19064-2510 |
Second Address | Springfield, PA 19064-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 17/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1393388 | (05) | PA |
679222 | PA BLUE SHIELD PROVIDER NUMBER (01) | PA |
E98056 | (02) | PA |