MEDICARE: MS. DANIELLE DEMARCO PA-C

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	363AS0400X	Surgical Physician Assistant	PA4172	MA
2	363A00000X	Physician Assistant	PA4172	MA
3	363A00000X	Physician Assistant	001418	CT

General Provider Information

NPI Number	:	1265603740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE DEMARCO PA-C

Provider Business Mailing Address
First Line	:	12 KEELING RD
Second Line	:
City	:	WAKEFIELD
State	:	MA
Zip	:	01880-2012
Country	:	US
Telephone Number	:	617-636-6086
Fax Number	:	617-636-2386

Provider Business Practice Location Address
First Line	:	91 MONTVALE AVE STE 208
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3649
Country	:	US
Telephone Number	:	617-636-6086
Fax Number	:	617-636-2386

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

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	02/13/2026

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