Provider Demographics
NPI:1023283967
Name:DAMASK PHYSICIANS GROUP PLLC
Entity type:Organization
Organization Name:DAMASK PHYSICIANS GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMASK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-829-8981
Mailing Address - Street 1:795 PRIMERA BLVD
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2191
Mailing Address - Country:US
Mailing Address - Phone:407-829-8981
Mailing Address - Fax:407-942-1049
Practice Address - Street 1:795 PRIMERA BLVD
Practice Address - Street 2:SUITE 1031
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2191
Practice Address - Country:US
Practice Address - Phone:407-829-8981
Practice Address - Fax:407-942-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFD6869861OtherBCBS