Provider Demographics
NPI:1679542732
Name:DERAMO, TONY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:THOMAS
Last Name:DERAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:THOMAS
Other - Last Name:DERAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5701 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-758-5779
Mailing Address - Fax:330-758-5747
Practice Address - Street 1:5701 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-758-5779
Practice Address - Fax:330-758-5747
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH26481207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100447Medicaid
D31783Medicare UPIN
OH0100447Medicaid