Healthcare Provider Details

I. General information

NPI: 1841289899
Provider Name (Legal Business Name): KENNETH M DEMARCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SILVERSIDE RD SUITE 3
WILMINGTON DE
19810-3719
US

IV. Provider business mailing address

2700 SILVERSIDE RD SUITE 3
WILMINGTON DE
19810-3719
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-0400
  • Fax: 302-478-3827
Mailing address:
  • Phone: 302-478-0400
  • Fax: 302-478-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC100003230
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: