Provider Demographics
NPI:1558401927
Name:DEMARCO, HEATHER (MED)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9496 PENDERGAST RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-9501
Mailing Address - Country:US
Mailing Address - Phone:315-382-7804
Mailing Address - Fax:
Practice Address - Street 1:9496 PENDERGAST RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-9501
Practice Address - Country:US
Practice Address - Phone:315-382-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator