Provider Demographics
NPI:1386769206
Name:JAMES J. DEMARCO M.D.
Entity type:Organization
Organization Name:JAMES J. DEMARCO M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-622-5196
Mailing Address - Street 1:4 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9327
Mailing Address - Country:US
Mailing Address - Phone:304-622-5196
Mailing Address - Fax:304-622-2810
Practice Address - Street 1:4 HOSPITAL PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9327
Practice Address - Country:US
Practice Address - Phone:304-622-5196
Practice Address - Fax:304-622-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17202207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF48491OtherUPIN
WV0075650000Medicaid
WV0075650000Medicaid