Provider Demographics
NPI:1427048891
Name:DEMASTERS, TROY A (PA)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:DEMASTERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FOGG RD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2432
Mailing Address - Country:US
Mailing Address - Phone:781-624-8000
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-624-8000
Practice Address - Fax:208-367-7092
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3777363A00000X
ID363A00000X
MAPA100230363A00000X
IDPA363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPAD35OtherBLUE CROSS MERIDIAN
AZZ127548Medicare PIN
ID000010154077OtherBLUE SHIELD MERIDIAN
IDP56542Medicare UPIN
ID806395600Medicaid
IDP00290516OtherRAILROAD MEDICARE
ID000010154078OtherBLUE SHIELD NAMPA
IDPAC00OtherBLUE CROSS NAMPA
AZ402707Medicaid
AZ402707Medicaid