Provider Demographics
NPI:1821114521
Name:JACK DEMOS, M.D., INC.
Entity Type:Organization
Organization Name:JACK DEMOS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-231-0200
Mailing Address - Street 1:2 ALLEGHENY CTR
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5402
Mailing Address - Country:US
Mailing Address - Phone:412-231-0200
Mailing Address - Fax:412-231-0613
Practice Address - Street 1:2 ALLEGHENY CTR
Practice Address - Street 2:SUITE 530
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5402
Practice Address - Country:US
Practice Address - Phone:412-231-0200
Practice Address - Fax:412-231-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
826866Medicare ID - Type Unspecified