MEDICARE: MELISSA DEMARCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	4078	SC

General Provider Information

NPI Number	:	1245874999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DEMARCO

Provider Business Mailing Address
First Line	:	1159 BLAKEWAY ST
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-8022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9313 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9155
Country	:	US
Telephone Number	:	843-847-4873
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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Directions to “ MELISSA DEMARCO ” Practice Location

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