Provider Demographics
NPI:1942309554
Name:DEGENNARO, MARC SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:SCOTT
Last Name:DEGENNARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 WHITEWOOD RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1668
Mailing Address - Country:US
Mailing Address - Phone:434-978-4473
Mailing Address - Fax:434-978-4644
Practice Address - Street 1:90 WHITEWOOD RD
Practice Address - Street 2:SUITE #2
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1668
Practice Address - Country:US
Practice Address - Phone:434-978-4473
Practice Address - Fax:434-978-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000076114OtherANTHEM PROVIDER NUMBER
VA54-1872882OtherTIN
VA54-1872882OtherTIN