Healthcare Provider Details

I. General information

NPI: 1962038323
Provider Name (Legal Business Name): PRISCO JOSEPH DEMERCURIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W PERIMETER RD
JB ANDREWS MD
20762-6601
US

IV. Provider business mailing address

1050 W PERIMETER RD
JB ANDREWS MD
20762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 240-612-1700
  • Fax:
Mailing address:
  • Phone: 240-612-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number324362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: