Individual
MINA MARIE DEMARCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
10322 BRISTOW CENTER DR, BRISTOW, VA 20136-2201
(571) 284-4230
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102203773
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100046947
—
WI
Enumeration date
06/23/2011
Last updated
03/28/2022
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