Basic Information
| Provider Information | |||||||||
| NPI: | 1093802134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMARCO | ||||||||
| FirstName: | ROMANO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13833 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191013833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522736818 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650301 | ||||||||
| FaxNumber: | 3522650627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2088P0231X | 7748 | SD | N | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 208800000X | ME117564 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 009625600 | 05 | FL | MEDICAID |