Provider Demographics
NPI:1548225832
Name:DEMANGONE, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:DEMANGONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6025 COMMERCE CIR
Mailing Address - Street 2:#2
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9668
Mailing Address - Country:US
Mailing Address - Phone:440-944-1414
Mailing Address - Fax:440-944-1445
Practice Address - Street 1:6025 COMMERCE CIR
Practice Address - Street 2:#2
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9668
Practice Address - Country:US
Practice Address - Phone:440-944-1414
Practice Address - Fax:440-944-1445
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35071438D208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000360726OtherBLUE CROSS/BLUE SHIELD
OH000000360726OtherANTHEM BLUE CROSS/BLUE SHIELD
OH050049657OtherRAILROAD MEDICARE
OH2008053Medicaid
OH2008053Medicaid
OH000000360726OtherANTHEM BLUE CROSS/BLUE SHIELD
OHG40043Medicare UPIN