Provider Demographics
NPI:1528047347
Name:DEMARIO, RALPH (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:DEMARIO
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 1:340 MONTAGE MT. ROAD
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507
Mailing Address - Country:US
Mailing Address - Phone:570-969-1669
Mailing Address - Fax:570-207-0883
Practice Address - Street 1:340 MOMTAGE MT ROAD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507
Practice Address - Country:US
Practice Address - Phone:570-969-1669
Practice Address - Fax:570-207-0883
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034548E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00114076Medicaid
C34525Medicare UPIN
PA475982Medicare PIN
PA00114076Medicaid