Provider Demographics
NPI:1760090807
Name:DEMETRO, ANTHONY PETER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PETER
Last Name:DEMETRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 ACKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4602
Mailing Address - Country:US
Mailing Address - Phone:330-904-8334
Mailing Address - Fax:
Practice Address - Street 1:2935 LINCOLN WAY NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5203
Practice Address - Country:US
Practice Address - Phone:330-236-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH50.007315RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program