Provider Demographics
NPI:1679508030
Name:DEMARINO, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:DEMARINO
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 1:2000 OXFORD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1827
Mailing Address - Country:US
Mailing Address - Phone:412-831-7570
Mailing Address - Fax:412-854-6149
Practice Address - Street 1:2000 OXFORD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1827
Practice Address - Country:US
Practice Address - Phone:412-831-7570
Practice Address - Fax:412-854-6149
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037984E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011050340004Medicaid
PA0011050340004Medicaid
A03035Medicare UPIN
PA0011050340004Medicaid