Provider Demographics
NPI:1841307782
Name:DEMARCO, PETER R (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:DEMARCO
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 1:8601 WEST DODGE RD
Mailing Address - Street 2:STE 234 DODGE PROFESSIONAL CENTER
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-393-8910
Mailing Address - Fax:402-393-3350
Practice Address - Street 1:8601 WEST DODGE RD
Practice Address - Street 2:STE 234 DODGE PROFESSIONAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-393-8910
Practice Address - Fax:402-393-3350
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10836207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0914416Medicaid
NE470535639Medicaid
NE470535639Medicaid
NEB67542Medicare UPIN