Provider Demographics
NPI:1154373009
Name:DEMARIA, JESS J (MD)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:J
Last Name:DEMARIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ALTAIR PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7647
Mailing Address - Country:US
Mailing Address - Phone:614-898-7546
Mailing Address - Fax:614-794-4294
Practice Address - Street 1:430 ALTAIR PKWY
Practice Address - Street 2:STE 210
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7647
Practice Address - Country:US
Practice Address - Phone:614-898-7546
Practice Address - Fax:614-794-4294
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055249207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000130129OtherANTHEM
0300024OtherUHC
0666955OtherAETNA
OH0775835Medicaid
OH0775835Medicaid
E32445Medicare UPIN