Healthcare Provider Details

I. General information

NPI: 1063807980
Provider Name (Legal Business Name): SEBASTIAN SALVATORE DEMARCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SALVATORE SEBASTIAN DEMARCO M.D.

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 1100
ALEXANDRIA VA
22304-1311
US

IV. Provider business mailing address

217 S FAYETTE ST
ALEXANDRIA VA
22314-3519
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-0073
  • Fax:
Mailing address:
  • Phone: 252-258-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0098057
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0098057
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number289340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: