DR. MARK A DEMIDOVICH (NPI# 1699859017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699859017 |
| Entity Type | Individual |
| Full Name | DR. MARK A DEMIDOVICH |
| Credential | M.D. |
| Practice Address |
233 George Junior Rd Grove City PA 16127 |
| Mailing Address |
233 George Junior Rd Grove City PA 16127-4417 |
| Practice Telephone | 7244213355 |
| Practice Fax Number | 7244060240 |
| Mailing Telephone | 7244213355 |
| Mailing Fax Number | 7244060240 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2018-09-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MD427222 | PA | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
MD427222 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | HIGHMARK PROVIDER # | 1879793 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4655 William Flynn Hwy, Suite 125b Coventry Square Office Center, Allison Park, PA 151012243 | 4124928585 | 4124927882 |
| Street Address |
233 GEORGE JUNIOR RD |
| City | GROVE CITY |
| State | PA |
| Zip Code | 16127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346281367 | Jason Edward Rock | Psychiatry & Neurology | 233 George Junior Rd, George Junior Republic In Pennsylvania, Grove City, PA 16127-4417 | 2006-06-09 |
| 1194389759 | Amanda Irons-bennett | Counselor | 233 George Junior Rd, Grove City, PA 16127-4417 | 2019-04-29 |
| 1831550409 | George Junior Republic In Pa | Psychiatric Residential Treatment Facility | 233 George Junior Rd, Grove City, PA 16127-4417 | 2016-03-10 |
| 1740591163 | George Junior Republic In Pa | Clinic/Center | 233 George Junior Rd, Grove City, PA 16127-4417 | 2010-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659907079 | Elaine Black Timko | Counselor | 113d North Broad Street, Grove City, PA 16127 | 2020-03-17 |
| 1457898082 | Jeffrey Ewell Scott | Speech-Language Pathologist | 435 Broad Street, Grove City, PA 16127 | 2017-01-20 |
| 1053651745 | Delta Foot and Ankle Center, LLC | Podiatrist | 247 N Broad Street Ext, Suite 204, Grove City, PA 16127 | 2013-02-18 |
| 1770786451 | Angela Dee Wells | Speech-Language Pathologist | 120 South Broad Street, Suite A, Grove City, PA 16127 | 2007-06-08 |
| 1780705202 | Cynthia Ann Ellermeyer | Speech-Language Pathologist | Grove City Medical Center, 631 North Broad St Ext, Grove City, PA 16127 | 2007-04-02 |
| 1083738884 | George Junior Republic In Pennsylvania | Community Based Residential Treatment Facility, Mental Illness | 233 George Junior Road, Grove City, PA 16127 | 2007-03-19 |
| 1932264058 | Alotad, Inc. | Durable Medical Equipment & Medical Supplies | 49 Pine Grove Pl., Grove City, PA 16127 | 2006-12-27 |
| 1396818233 | Thomas William Lah | Dentist | 1235 South Center S. Ext, Suite 935, Grove City, PA 16127 | 2006-11-16 |
| 1275619777 | Donald Harold Wykoff | Psychologist | 1049 Slippery Rock Rd, Grove City, PA 16127 | 2006-10-27 |
| 1336235100 | James W Eaton II | Dentist | 407 N Broad St, Grove City, PA 16127 | 2006-10-05 |
| Find all providers in zip 16127 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255932174 | Northeast Counseling Service | Psychiatry & Neurology | 85 S Old Turnpike Rd, Drums, PA 18222-1731 | 2020-11-06 |
| 1639770647 | Northeast Counseling Service | Psychiatry & Neurology | 275 Mill St, Hazleton, PA 18201-6701 | 2020-11-05 |
| 1225645518 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 723 Coal St, Easton, PA 18042-6556 | 2020-09-30 |
| 1093322380 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 990 Echo Trl, Easton, PA 18040-1014 | 2020-09-30 |
| 1720695141 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 429 Reeder St, Easton, PA 18042-1731 | 2020-09-29 |
| 1710594130 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1709 Richmond Rd, Easton, PA 18040-8435 | 2020-09-29 |
| 1528675345 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1315 Echo Trl, Easton, PA 18040-1019 | 2020-09-25 |
| 1164039996 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1243 Tatamy Rd, Easton, PA 18045-7405 | 2020-09-25 |
| 1578170304 | St. Luke's Physician Group, Inc. | Psychiatry & Neurology | 1221 Northampton St, Easton, PA 18042-4138 | 2020-09-25 |
| 1336754951 | Evergreen Psychiatry LLC | Psychiatry & Neurology | 539 S Bolmar St, West Chester, PA 19382-4934 | 2020-09-10 |
| Find all providers with the same taxonomy | ||||
| City | GROVE CITY |
| Zip Code | 16127 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.