Provider Demographics
NPI:1679643183
Name:DEMETRIO J AGCAOILI MD LLC
Entity Type:Organization
Organization Name:DEMETRIO J AGCAOILI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:AGCAOILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-695-3703
Mailing Address - Street 1:51520 NATIONAL ROAD E
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAINTCLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8213
Mailing Address - Country:US
Mailing Address - Phone:740-296-5931
Mailing Address - Fax:740-296-5942
Practice Address - Street 1:51520 NATIONAL ROAD E
Practice Address - Street 2:SUITE 5
Practice Address - City:SAINTCLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8213
Practice Address - Country:US
Practice Address - Phone:740-296-5931
Practice Address - Fax:740-296-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083354207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841957000Medicaid
OH2413267Medicaid
OH2413267Medicaid
G65747Medicare UPIN
OHAG4124272Medicare PIN