Provider Demographics
NPI:1316162605
Name:ANTHONY N. DEMEO, MD, INC.
Entity type:Organization
Organization Name:ANTHONY N. DEMEO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:DEMEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-939-3437
Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-939-3437
Mailing Address - Fax:925-939-7814
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-939-3437
Practice Address - Fax:925-939-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21979207RA0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G219790Medicaid
CAS99Y6OtherEMPIRE BC BS
CAA41444Medicare UPIN
CAS99Y6OtherEMPIRE BC BS