MEDICARE: DR. THOMAS PATRICK DEMARINI MD

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	207RP1001X	Pulmonary Disease Physician	032171	GA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	032171	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	110093072	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0932200001	OTHER	GA	WORKERS COMPENSATION
2	4806430	OTHER		UNITED HEALTHCARE
3	4092541	OTHER		AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1407831696	OTHER	GA	NPI
6	264495	OTHER	GA	BLUE CROSS BLUE SHIELD
7	5930	OTHER	GA	KAISER
8	2138458010	OTHER		CIGNA
10	2999931	OTHER		GHI

General Provider Information

NPI Number	:	1407831696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PATRICK DEMARINI MD

Provider Business Mailing Address
First Line	:	2665 N DECATUR RD
Second Line	:	STE 430
City	:	DECATUR
State	:	GA
Zip	:	30033-6145
Country	:	US
Telephone Number	:	404-294-4018
Fax Number	:	404-294-9161

Provider Business Practice Location Address
First Line	:	2665 N DECATUR RD
Second Line	:	STE 430
City	:	DECATUR
State	:	GA
Zip	:	30033-6145
Country	:	US
Telephone Number	:	404-294-4018
Fax Number	:	404-294-1359

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	01/25/2010

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