Provider Demographics
NPI:1790780724
Name:DEMARIA, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DEMARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 MEDICAL PLZ
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2101
Mailing Address - Country:US
Mailing Address - Phone:516-676-0239
Mailing Address - Fax:516-676-0956
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:SUITE 303
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2101
Practice Address - Country:US
Practice Address - Phone:516-676-0239
Practice Address - Fax:516-676-0956
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY160671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94643Medicare UPIN
NYE31E471Medicare UPIN