1235106436 NPI number — CONSTANTINA DEMOU DPM

Table of content: CONSTANTINA DEMOU DPM (NPI 1235106436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235106436 NPI number — CONSTANTINA DEMOU DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMOU
Provider First Name:
CONSTANTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235106436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON LAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44012-0203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-930-2503
Provider Business Mailing Address Fax Number:
440-930-4340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 VINTAGE PT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON LAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44012-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-930-2503
Provider Business Practice Location Address Fax Number:
440-930-4340
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36003147 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2312607 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com