Provider Demographics
NPI:1619946936
Name:DEMARCO, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1370 JOHNSON AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1378
Mailing Address - Country:US
Mailing Address - Phone:304-622-5196
Mailing Address - Fax:304-622-2810
Practice Address - Street 1:1370 JOHNSON AVE
Practice Address - Street 2:STE 203
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1378
Practice Address - Country:US
Practice Address - Phone:304-622-5196
Practice Address - Fax:304-622-2810
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WVWV17202207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075650000Medicaid
WVDE0740582Medicare ID - Type Unspecified
WV0075650000Medicaid