Healthcare Provider Details

I. General information

NPI: 1780840785
Provider Name (Legal Business Name): MICHELLE CHIARINA DEMARCO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 08/15/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S GOVERNORS AVE STE 101A
DOVER DE
19904-3530
US

IV. Provider business mailing address

640 S. STATE ST., MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7980
  • Fax: 302-744-7989
Mailing address:
  • Phone: 302-744-7980
  • Fax: 302-744-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011962
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: