Provider Demographics
NPI:1124043948
Name:DEMARIA, ANTHONY N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:N
Last Name:DEMARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE 8411
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-6031
Mailing Address - Fax:619-543-3305
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8411
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-6031
Practice Address - Fax:619-543-3305
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20471207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G204710Medicaid
CAWG20471BMedicare ID - Type Unspecified
CAA40939Medicare UPIN
CAWG20471AMedicare ID - Type Unspecified