Provider Demographics
NPI:1184606428
Name:DEMARCO, LUCINDA (MD)
Entity type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2787
Mailing Address - Country:US
Mailing Address - Phone:843-599-0817
Mailing Address - Fax:843-782-2331
Practice Address - Street 1:501 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2787
Practice Address - Country:US
Practice Address - Phone:843-599-0817
Practice Address - Fax:843-782-2331
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057518208000000X
VA0101250144208000000X
SC30247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200429360Medicaid
VA1184606428Medicaid
SC302470Medicaid
OH0791148Medicaid
F05044Medicare UPIN
VA1184606428Medicaid