Provider Demographics
NPI:1568480671
Name:DEMARCO, PAUL VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:VINCENT
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 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:121 S EVANDER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-4212
Practice Address - Country:US
Practice Address - Phone:843-432-2935
Practice Address - Fax:843-799-4297
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL7222Medicaid
SCTL7222Medicaid
SCTL7222Medicaid
SCF574425117Medicare PIN