Provider Demographics
NPI:1568133072
Name:CARELLAS, DEMETRIOS (PA-C)
Entity type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:
Last Name:CARELLAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2675
Mailing Address - Country:US
Mailing Address - Phone:508-595-2513
Mailing Address - Fax:508-595-2021
Practice Address - Street 1:378 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2675
Practice Address - Country:US
Practice Address - Phone:508-595-2513
Practice Address - Fax:508-595-2021
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062999363AM0700X
MAPA100323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110212481AMedicaid