Provider Demographics
NPI:1427066653
Name:DEMETER, JOSEPH GERARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:DEMETER
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 1:30 W MCCREIGHT AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1842
Mailing Address - Country:US
Mailing Address - Phone:937-399-7021
Mailing Address - Fax:937-399-0697
Practice Address - Street 1:30 W MCCREIGHT AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1842
Practice Address - Country:US
Practice Address - Phone:937-399-7021
Practice Address - Fax:937-399-0697
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-06-3244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882988Medicaid
F34286Medicare UPIN
OHDE0721461Medicare ID - Type Unspecified