Provider Demographics
NPI:1902001514
Name:DEMICCO, ELIZABETH G (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:DEMICCO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:857-205-5960
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:857-205-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242314207ZP0101X
TXN5648207ZP0101X
NY264869207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology