Basic Information
Provider Information
NPI: 1700400546
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMUS
FirstName: ERICA
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5982 RHODES RD
Address2:  
City: KENT
State: OH
PostalCode: 442408100
CountryCode: US
TelephoneNumber: 3306731347
FaxNumber: 3306783677
Practice Location
Address1: 732 N 6TH AVE
Address2:  
City: STEUBENVILLE
State: OH
PostalCode: 439521841
CountryCode: US
TelephoneNumber: 7402841400
FaxNumber: 7402825828
Other Information
ProviderEnumerationDate: 06/07/2020
LastUpdateDate: 06/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


Home