Provider Demographics
NPI:1184612855
Name:DEMELO, RUI G (DPM)
Entity type:Individual
Prefix:
First Name:RUI
Middle Name:G
Last Name:DEMELO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SUMMER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5510
Mailing Address - Country:US
Mailing Address - Phone:203-323-1171
Mailing Address - Fax:203-323-4649
Practice Address - Street 1:1234 SUMMER ST STE 202
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5510
Practice Address - Country:US
Practice Address - Phone:203-323-1171
Practice Address - Fax:203-323-4649
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000783213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V4758OtherHEALTHNET
CTP3064982OtherOXFORD
CT95809OtherAETNA
CT030000783CT01OtherBLUE CROSS
CTU94257Medicare UPIN
CT030000783CT01OtherBLUE CROSS