Basic Information
| Provider Information | |||||||||
| NPI: | 1841253515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMARCO | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 706152 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452706152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136195014 | ||||||||
| FaxNumber: | 5136198713 | ||||||||
| Practice Location | |||||||||
| Address1: | 6480 HARRISON AVENUE | ||||||||
| Address2: | SUITE #302 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133891400 | ||||||||
| FaxNumber: | 5139223444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 01/12/2011 | ||||||||
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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 | 207Q00000X | 35085936 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.