Provider Demographics
NPI:1174915987
Name:DEMIDOVA, OLGA (DO)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:DEMIDOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37045 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1238
Mailing Address - Country:US
Mailing Address - Phone:216-804-5996
Mailing Address - Fax:216-758-4783
Practice Address - Street 1:37045 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:MORELAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44022-1238
Practice Address - Country:US
Practice Address - Phone:216-804-5996
Practice Address - Fax:216-758-4783
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14719207N00000X, 207ND0101X
OH34.012494207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty