Provider Demographics
NPI:1689810012
Name:DEMASI DIGESTIVE HEALTH PA
Entity Type:Organization
Organization Name:DEMASI DIGESTIVE HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DEMASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-584-6272
Mailing Address - Street 1:1370 E. VENICE AVE.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9084
Mailing Address - Country:US
Mailing Address - Phone:941-584-6272
Mailing Address - Fax:
Practice Address - Street 1:1370 E. VENICE AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-9084
Practice Address - Country:US
Practice Address - Phone:941-584-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 66068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG67066Medicare UPIN
FLE0495Medicare PIN