Provider Demographics
NPI:1659313419
Name:DEMEDIO, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:DEMEDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2510
Mailing Address - Country:US
Mailing Address - Phone:610-328-3345
Mailing Address - Fax:888-251-9664
Practice Address - Street 1:46 GREENHILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2510
Practice Address - Country:US
Practice Address - Phone:610-328-3345
Practice Address - Fax:888-251-9664
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042141-E207Q00000X
PAMD042141E207R00000X, 207QA0000X, 207QS0010X, 207P00000X, 2083X0100X, 2084P0800X, 171100000X, 173000000X, 171WH0202X, 207QA0401X, 207QB0002X, 207QG0300X, 208M00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No171100000XOther Service ProvidersAcupuncturist
No173000000XOther Service ProvidersLegal Medicine
No171WH0202XOther Service ProvidersContractorHome Modifications
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1393388Medicaid
PA679222OtherPA BLUE SHIELD PROVIDER NUMBER
PA679222OtherPA BLUE SHIELD PROVIDER NUMBER