Provider Demographics
NPI:1386703494
Name:DEMARCO, ROBERT P (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN-534694163W00000X
PA076873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2797880000OtherIBC
PA1027802710001Medicaid
PA11803015OtherCAQH
PA1928847OtherFIRST PRIORITY
PA104165OtherGEISINGER
PA1580788OtherGATEWAY
PA1928847OtherHIGHMARK
PA50065559OtherCAPITAL ADVANTAGE
PA9482478OtherAETNA
PA104165OtherGEISINGER
PA11803015OtherCAQH