Provider Demographics
NPI:1902940968
Name:DE MARCO, LUCIANO E (MD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:E
Last Name:DE MARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 COLUMBUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1732
Mailing Address - Country:US
Mailing Address - Phone:914-761-9117
Mailing Address - Fax:914-761-7731
Practice Address - Street 1:137 COLUMBUS AVENUE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1732
Practice Address - Country:US
Practice Address - Phone:914-761-9117
Practice Address - Fax:914-761-7731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY145754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWP754OtherOXFORD
NYLD030D1010OtherEMPIRE BLUE CROSS BLUE SHIELD
NY0068360OtherGHI
NY30D101OtherMEDICARE ID- TYPE UNSPECIFIED
NY3C0527OtherHEALTH NET
GA110014726OtherPALMETTO GBA
NY3C0527OtherHEALTH NET