Basic Information
| Provider Information | |||||||||
| NPI: | 1730852310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMARCO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1161 BETHEL RD STE 203 204 | ||||||||
| Address2: | SUITE 203 & 204 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144590350 | ||||||||
| FaxNumber: | 6144590355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1161 BETHEL RD STE 203 204 | ||||||||
| Address2: | SUITE 203 & 204 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144590350 | ||||||||
| FaxNumber: | 6144590355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.0029287 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.