Provider Demographics
NPI:1780201731
Name:DEMARCO, BETHANY (DPM)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 NORTH RD STE 304
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:845-437-5060
Mailing Address - Fax:
Practice Address - Street 1:696 DUTCHESS TPKE STE M
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6429
Practice Address - Country:US
Practice Address - Phone:845-454-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN007332213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA400322400OtherMEDICARE
NY07733448Medicaid