Doctor Name: | PHILIP M DEMOLA |
NPI Number: | 1942484688 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | OT012076 |
Business Practice Address: | 1381 S Patrick Dr Patrick Afb, FL - 329253606 |
Business Phone Number: | 3214940933 |
Business Fax Number: | |
Mailing Address: | 2590 Revolution St, Unit 106 MELBOURNE |
State: | FL |
Postal Code: | 329353855 |
Phone Number: | 6107151574 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2007 |
NPI Last Update Date: | 05/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | OT012076 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |