Healthcare Provider Details
I. General information
NPI: 1659313419
Provider Name (Legal Business Name): WILLIAM JOSEPH DEMEDIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/12/2006
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:
III. Provider practice location address
46 GREENHILL RD
SPRINGFIELD PA
19064-2510
US
IV. Provider business mailing address
46 GREENHILL RD
SPRINGFIELD PA
19064-2510
US
V. Phone/Fax
- Phone: 610-328-3345
- Fax: 888-251-9664
- Phone: 610-328-3345
- Fax: 888-251-9664
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | MD042141-E |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0000X |
| Taxonomy | Adolescent Medicine (Family Medicine) Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QS0010X |
| Taxonomy | Sports Medicine (Family Medicine) Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083X0100X |
| Taxonomy | Occupational Medicine Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171100000X |
| Taxonomy | Acupuncturist |
| License Number | MD042141E |
| License Number State | PA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 173000000X |
| Taxonomy | Legal Medicine |
| License Number | MD042141E |
| License Number State | PA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171WH0202X |
| Taxonomy | Home Modifications Contractor |
| License Number | MD042141E |
| License Number State | PA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QA0401X |
| Taxonomy | Addiction Medicine (Family Medicine) Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QB0002X |
| Taxonomy | Obesity Medicine (Family Medicine) Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207QG0300X |
| Taxonomy | Geriatric Medicine (Family Medicine) Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | MD042141E |
| License Number State | PA |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | MD042141E |
| License Number State | PA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
