Provider Demographics
NPI:1558439414
Name:DEMETRIOU, EMILY T (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:T
Last Name:DEMETRIOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:175 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9048
Practice Address - Country:US
Practice Address - Phone:207-885-7700
Practice Address - Fax:207-885-7701
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17573207RE0101X, 207R00000X
NH15827207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207219Medicaid
ME432726299Medicaid
ME000297804Medicare PIN
MEP01059148Medicare PIN
ME000297802Medicare PIN
ME432726299Medicaid
ME000297803Medicare PIN
ME000297807Medicare PIN