Provider Demographics
NPI:1215975065
Name:DEMARCO, PAUL S (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2630
Mailing Address - Country:US
Mailing Address - Phone:609-927-4894
Mailing Address - Fax:609-601-1439
Practice Address - Street 1:401 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2630
Practice Address - Country:US
Practice Address - Phone:609-927-4894
Practice Address - Fax:609-601-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02049213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0500375000OtherAMERIHEALTH HMO ID
NJ1087436OtherHORIZON NJ HEALTH ID
NJ6272801Medicaid
NJP647797OtherOXFORD HEALTH ID
NJ0841409000OtherAMERIHEALTH PRACTICE ID
NJ2556601OtherAETNA ID
NJ667461Medicare ID - Type UnspecifiedPROVIDER NUMBER
U18199Medicare UPIN