Provider Demographics
NPI:1609059112
Name:DEMIDOVICH, JOSEPH STEPHEN III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:DEMIDOVICH
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:609 W. GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3352
Mailing Address - Country:US
Mailing Address - Phone:610-275-2446
Mailing Address - Fax:610-275-3266
Practice Address - Street 1:1569 MEDICAL DR STE 202
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3223
Practice Address - Country:US
Practice Address - Phone:484-948-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08581900207RP1001X
PAOS014147207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027179750001Medicaid
PA241037EN2Medicare PIN