Healthcare Provider Details

I. General information

NPI: 1689771792
Provider Name (Legal Business Name): ROBERT DEMARCO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 MAGUIRE RD SUITE 270
OCOEE FL
34761-4749
US

IV. Provider business mailing address

11319 SHANDON PARK WAY
WINDERMERE FL
34786-6063
US

V. Phone/Fax

Practice location:
  • Phone: 407-255-8144
  • Fax: 407-641-9528
Mailing address:
  • Phone: 407-258-8570
  • Fax: 407-641-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35059825
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME103204
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35059825
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: