Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000783 | CT |
N | 213ES0103X | Foot & Ankle Surgery | 000783 | CT |
NPI | 1184612855 |
---|---|
Provider Name | Rui G Demelo |
First Address | Stamford, CT 06905-5510 |
Second Address | Stamford, CT 06905-5510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030000783CT01 | BLUE CROSS (01) | CT |
2V4758 | HEALTHNET (01) | CT |
95809 | AETNA (01) | CT |
P3064982 | OXFORD (01) | CT |
U94257 | (02) | CT |