Provider Demographics
NPI:1588776124
Name:DEMERS M.D., CARRIE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:DEMERS M.D.
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 BETHANY TPKE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4194
Mailing Address - Country:US
Mailing Address - Phone:570-253-5551
Mailing Address - Fax:570-253-4164
Practice Address - Street 1:952 BETHANY TPKE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4194
Practice Address - Country:US
Practice Address - Phone:570-253-5551
Practice Address - Fax:570-253-4164
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056330L207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563691Medicare ID - Type UnspecifiedDE-ACTIVATED; REAPPLYING