Provider Demographics
NPI:1124040951
Name:AGCAOILI, DEMETRIO J (MD)
Entity Type:Individual
Prefix:MR
First Name:DEMETRIO
Middle Name:J
Last Name:AGCAOILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51520 NATIONAL ROAD E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAINT CLARISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8213
Mailing Address - Country:US
Mailing Address - Phone:740-296-5931
Mailing Address - Fax:740-296-5942
Practice Address - Street 1:51520 NATIONAL ROAD E
Practice Address - Street 2:SUITE 5
Practice Address - City:SAINT CLARISVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8213
Practice Address - Country:US
Practice Address - Phone:740-296-5931
Practice Address - Fax:740-296-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV21203207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841957000Medicaid
OH2413267Medicaid
WV4197771Medicare PIN
WV1841957000Medicaid
OH4124272Medicare PIN