Provider Demographics
NPI:1245253889
Name:DEMARCHI, JOHN JAMES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:DEMARCHI
Suffix:
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 1:3673 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1740
Mailing Address - Country:US
Mailing Address - Phone:716-662-8093
Mailing Address - Fax:716-662-2969
Practice Address - Street 1:3673 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1740
Practice Address - Country:US
Practice Address - Phone:716-662-8093
Practice Address - Fax:716-662-2969
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104410207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00674488Medicaid
NY064491Medicare ID - Type Unspecified
NY00674488Medicaid