Provider Demographics
NPI:1841471364
Name:DEMAYO, WILLIAM M (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:DEMAYO
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 1:360 GOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3400
Mailing Address - Country:US
Mailing Address - Phone:814-288-4448
Mailing Address - Fax:814-288-4477
Practice Address - Street 1:360 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3400
Practice Address - Country:US
Practice Address - Phone:814-288-4448
Practice Address - Fax:814-288-4477
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059344L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA436893Q12OtherMEDICARE