Provider Demographics
NPI:1497817373
Name:DEMETRIUS, CLAUDETTE EMMELINE
Entity Type:Individual
Prefix:MRS
First Name:CLAUDETTE
Middle Name:EMMELINE
Last Name:DEMETRIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13529 GEORGIA AVE
Mailing Address - Street 2:APARTMENT 203
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906
Mailing Address - Country:US
Mailing Address - Phone:301-946-3338
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDRICK AVE
Practice Address - Street 2:#12
Practice Address - City:GEITHERSBERG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:301-208-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD991558374U00000X
MDA00015852163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00015852OtherCERTIFIED GERIATRIC NURSE
MD4387007-00OtherMEDICAL ASSISTANCE
MD714564100Medicaid