Healthcare Provider Details

I. General information

NPI: 1316162605
Provider Name (Legal Business Name): ANTHONY N. DEMEO, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR SUITE 305
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR SUITE 305
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-3437
  • Fax: 925-939-7814
Mailing address:
  • Phone: 925-939-3437
  • Fax: 925-939-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG21979
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG21979
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY N DEMEO
Title or Position: OWNER
Credential: MD
Phone: 925-939-3437