MEDICARE: DR. OLGA DEMIDOVA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	OS14719	FL
2	207ND0101X	MOHS-Micrographic Surgery Physician	OS14719	FL
3	207ND0101X	MOHS-Micrographic Surgery Physician	34.01294	OH
4	207N00000X	Dermatology Physician	34.012494	OH

General Provider Information

NPI Number	:	1174915987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA DEMIDOVA DO

Provider Business Mailing Address
First Line	:	37045 CHAGRIN BLVD
Second Line	:
City	:	MORELAND HILLS
State	:	OH
Zip	:	44022-1238
Country	:	US
Telephone Number	:	216-804-5996
Fax Number	:	216-758-4783

Provider Business Practice Location Address
First Line	:	37045 CHAGRIN BLVD
Second Line	:
City	:	MORELAND HILLS
State	:	OH
Zip	:	44022-1238
Country	:	US
Telephone Number	:	216-804-5996
Fax Number	:	216-758-4783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	08/04/2025

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Directions to “ DR. OLGA DEMIDOVA DO” Practice Location

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