Provider Demographics
NPI:1811017759
Name:ADARMES, DEMITRI (MD)
Entity Type:Individual
Prefix:
First Name:DEMITRI
Middle Name:
Last Name:ADARMES
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:PO BOX 5277
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 LILLY RD NE
Practice Address - Street 2:BLDG 1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5102
Practice Address - Country:US
Practice Address - Phone:360-352-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045379207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7130461Medicaid
WA8439390Medicaid
WA7131626Medicaid
WA7130461Medicaid
WA8857551Medicare ID - Type UnspecifiedPERFORMING PROV ID #
WA8857550Medicare ID - Type UnspecifiedBILLING PROVIDER ID #