Provider Demographics
NPI:1972692473
Name:DEMIDONT, ADRIAN C (DO)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:C
Last Name:DEMIDONT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4008
Mailing Address - Country:US
Mailing Address - Phone:203-852-9525
Mailing Address - Fax:203-852-9525
Practice Address - Street 1:2200 WHITNEY AVENUE
Practice Address - Street 2:SUITE 290
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518
Practice Address - Country:US
Practice Address - Phone:203-903-8308
Practice Address - Fax:203-599-3927
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246575207R00000X, 207RI0200X
CT53610207R00000X, 207RI0200X
PAOS011985207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1800377OtherHIGHMARK BLUE SHIELD
PA50065530OtherCAPITAL BLUE CROSS
PA101535889Medicaid
NYA400052336OtherMEDICARE PTAN
PA50065530OtherCAPITAL BLUE CROSS
PA098032Medicare ID - Type Unspecified