Basic Information
Provider Information
NPI: 1376538546
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMASI
FirstName: CLEMENT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2350 SCENIC DR
Address2: SENIOR FRIENDSHIP CENTERS, INC.
City: VENICE
State: FL
PostalCode: 342931510
CountryCode: US
TelephoneNumber: 9415840043
FaxNumber: 9414968627
Practice Location
Address1: 2350 SCENIC DR
Address2: SENIOR FRIENDSHIP CENTERS, INC.
City: VENICE
State: FL
PostalCode: 342931510
CountryCode: US
TelephoneNumber: 9415840043
FaxNumber: 9414968627
Other Information
ProviderEnumerationDate: 09/14/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XLL612FLY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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