Provider Demographics
NPI:1477511459
Name:DEMARCO, DINA SOPHIA (MS, RPA-C)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:SOPHIA
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:MS, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4306
Mailing Address - Country:US
Mailing Address - Phone:256-539-2728
Mailing Address - Fax:256-539-2666
Practice Address - Street 1:927 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4306
Practice Address - Country:US
Practice Address - Phone:256-539-2728
Practice Address - Fax:256-539-2666
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1134363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000064956Medicare PIN
UT107044674101OtherINTERMOUNTAIN HEALTHCARE
UTQ29917Medicare UPIN
UT005705502Medicare ID - Type Unspecified
UT043651337DEMOtherEDUCATORS MUTUAL