Basic Information
| Provider Information | |||||||||
| NPI: | 1285616854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMASON | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 THOMPSON ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366239118 | ||||||||
| FaxNumber: | 3366231902 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 THOMPSON ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366239118 | ||||||||
| FaxNumber: | 3366231902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 27157 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 032953 | 01 | VA | ANTHEM | OTHER | 28320 | 01 | NC | BLUE CROSS BLUE SHIELD NC | OTHER | 37469 | 01 | NC | MEDCOST | OTHER | 4155 | 01 | NC | PARTNERS MEDICARE | OTHER | 5778367 | 01 | NC | AETNA | OTHER | 7350325 | 01 | VA | VIRGINIA MEDICAL ASSISTAN | OTHER | 7928320 | 05 | NC | MEDICAID |