Provider Demographics
NPI:1528139086
Name:DEMASI, RONALD W (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:DEMASI
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 1:1370 E VENICE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9082
Mailing Address - Country:US
Mailing Address - Phone:941-584-6272
Mailing Address - Fax:941-584-6276
Practice Address - Street 1:1370 E VENICE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-9082
Practice Address - Country:US
Practice Address - Phone:941-584-6272
Practice Address - Fax:941-584-6276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG67066Medicare UPIN
FLE0495ZMedicare ID - Type Unspecified
FLBN115AMedicare PIN