Provider Demographics
NPI:1538127444
Name:CLEMENT J DEMASI MD PA
Entity Type:Organization
Organization Name:CLEMENT J DEMASI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:636-549-2384
Mailing Address - Street 1:1203 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4519
Mailing Address - Country:US
Mailing Address - Phone:941-492-9756
Mailing Address - Fax:941-493-8941
Practice Address - Street 1:1203 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4519
Practice Address - Country:US
Practice Address - Phone:941-492-9756
Practice Address - Fax:941-493-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66068207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG67066Medicare UPIN
FLG50016Medicare UPIN