Provider Demographics
NPI:1457357790
Name:DEMAIO, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:DEMAIO
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 1:233 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEONA
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3230
Mailing Address - Country:US
Mailing Address - Phone:717-270-1995
Mailing Address - Fax:717-274-5889
Practice Address - Street 1:233 W PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-3230
Practice Address - Country:US
Practice Address - Phone:717-270-1995
Practice Address - Fax:717-274-5889
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057734L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG26475Medicare UPIN
PA865241LN2Medicare ID - Type Unspecified