Individual provider Active NPI

Olga Demidova, DO

  • MOHS-Micrographic Surgery Physician
  • Tampa, FL
National Provider Identifier
1174915987
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
34.01294 Issued in OH
Practice address
9724 N Armenia Ave Ste 300
Tampa, FL 33612-7550
Phone
(216) 804-5996
Fax
(216) 758-4783
NPI assigned
Mar 3, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X OS14719 FL
Dermatology Physician 207N00000X 34.012494 OH
MOHS-Micrographic Surgery Physician 207ND0101X 34.01294 OH Primary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X OS14719 FL

Addresses

Primary practice location

9724 N Armenia Ave Ste 300
Tampa, FL 33612-7550

Mailing address

9724 N Armenia Ave Ste 300
Tampa, FL 33612-7550
Phone (216) 804-5996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191104000461 OH Practitioner - Dermatology 7113227935 Reassigns benefits to 1 organization
I20230915000958 FL Practitioner - Dermatology 7113227935 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Ohio University, College of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Metrohealth SystemGroup PAC ID 8628982949, 1,150 clinicians

Practice addresses (Care Compare)

2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone (216) 778-7800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS14719FLMDMOHS-Micrographic Surgery Physician
34.01294OHMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Multi-Specialty CurrentSince Oct 1, 2019 Accepting new patients
The Metrohealth System CurrentSince Oct 1, 2019 Accepting new patients
The Metrohealth System Current Accepting new patients
Mason Dermatology Center Inc Multi-Specialty Past Accepting new patients
Western Reserve Dermatology, Inc Multi-Specialty PastSince Nov 20, 2019 Accepting new patients

Locations

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

4229 Pearl Rd
Cleveland, OH 44109
Phone (216) 459-6300

Interoperability endpoints

  • Direct secure messaging: odemidova166248@direct.metrohealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780531200000",
    "number": "1174915987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9724 N ARMENIA AVE STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127550",
            "telephone_number": "216-804-5996",
            "fax_number": "216-758-4783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9724 N ARMENIA AVE STE 300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336127550",
            "telephone_number": "216-804-5996",
            "fax_number": "216-758-4783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMIDOVA",
        "first_name": "OLGA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "OS14719",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "34.012494",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "OH",
            "license": "34.01294",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "OS14719",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.