Provider Demographics
NPI:1417972605
Name:DIMARCO, PAUL L (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:L
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2615 CULVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1746
Mailing Address - Country:US
Mailing Address - Phone:585-336-5320
Mailing Address - Fax:585-336-9114
Practice Address - Street 1:2615 CULVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1746
Practice Address - Country:US
Practice Address - Phone:585-336-5320
Practice Address - Fax:585-336-9114
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY150400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033696Medicaid
NY1033696Medicaid
NYCC8064Medicare ID - Type Unspecified