Provider Demographics
NPI:1821654948
Name:DAVID A. DEMANGONE LLC
Entity Type:Organization
Organization Name:DAVID A. DEMANGONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMANGONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-944-1414
Mailing Address - Street 1:6025 COMMERCE CIR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9694
Mailing Address - Country:US
Mailing Address - Phone:440-944-1414
Mailing Address - Fax:
Practice Address - Street 1:6025 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9694
Practice Address - Country:US
Practice Address - Phone:440-944-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies