Provider Demographics
NPI:1689771792
Name:DEMARCO, ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:DEMARCO
Suffix:JR
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 1:11319 SHANDON PARK WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6063
Mailing Address - Country:US
Mailing Address - Phone:407-258-8570
Mailing Address - Fax:407-641-9528
Practice Address - Street 1:2582 MAGUIRE RD
Practice Address - Street 2:SUITE 270
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4749
Practice Address - Country:US
Practice Address - Phone:407-255-8144
Practice Address - Fax:407-641-9528
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059825207RP1001X, 207RC0200X
FLME103204207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000028616OtherANTHEM
OHDE0673482OtherPIN
OHDE0673483OtherPIN
OH0793897Medicaid
OH000000130414OtherANTHEM
OHPU9928771Medicare ID - Type Unspecified
FLDP393ZMedicare PIN
OH000000130414OtherANTHEM
OHDE0673483OtherPIN