Provider Demographics
NPI:1285616854
Name:DEMASON, MARC (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:DEMASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 THOMPSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5068
Mailing Address - Country:US
Mailing Address - Phone:336-623-9118
Mailing Address - Fax:336-623-1902
Practice Address - Street 1:515 THOMPSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5068
Practice Address - Country:US
Practice Address - Phone:336-623-9118
Practice Address - Fax:336-623-1902
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27157208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA032953OtherANTHEM
NC28320OtherBLUE CROSS BLUE SHIELD NC
NC37469OtherMEDCOST
NC4155OtherPARTNERS MEDICARE
NC5778367OtherAETNA
VA7350325OtherVIRGINIA MEDICAL ASSISTAN
NC7928320Medicaid
VA032953OtherANTHEM
NCC87742Medicare UPIN