Provider Demographics
NPI:1972576197
Name:DEMARCO, ANDREW D (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12620 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8662
Mailing Address - Country:US
Mailing Address - Phone:724-933-4700
Mailing Address - Fax:412-347-4048
Practice Address - Street 1:12620 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8662
Practice Address - Country:US
Practice Address - Phone:724-933-4700
Practice Address - Fax:412-347-4048
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047727L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013042430014Medicaid
PAF40387Medicare UPIN
PA143311R7RMedicare PIN