Healthcare Provider Details

I. General information

NPI: 1942284377
Provider Name (Legal Business Name): ANTHONY P DEMARIA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 BURLINGTON PIKE STE 2
FLORENCE KY
41042-1600
US

IV. Provider business mailing address

7033 BURLINGTON PIKE STE 2
FLORENCE KY
41042-1600
US

V. Phone/Fax

Practice location:
  • Phone: 859-746-3668
  • Fax:
Mailing address:
  • Phone: 859-746-3668
  • Fax: 859-746-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number244128
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number244128
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number244128
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number244128
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number270
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0585
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberKY00270
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number244128
License Number StateKY
# 9
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number244128
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: