Organization
NICOLA DEMACOPOULOS MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLA D DEMACOPOULSO MD (PRESIDENT)
(330) 638-0068
Entity
Organization
Contact information
Practice address
310 WINSOR DRIVE, CORTLAND, OH 44410-2705
(330) 638-0068
(330) 637-0067
Mailing address
310 WINSOR DRIVE, CORTLAND, OH 44410-2705
(330) 638-0068
(330) 637-0067
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35063150D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000283762
ANTHEM
—
05
—
0874915
—
OH
Enumeration date
06/05/2007
Last updated
09/16/2009
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