Individual
DEBORAH D DEMICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 CRYSTAL SPRING AVE SW, SUITE 301, ROANOKE, VA 24014-2462
(540) 981-7165
(540) 983-1133
Mailing address
3345 ONE OAK RD, ROANOKE, VA 24018-2642
(540) 989-4424
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
0101-039288
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5886112
—
VA
05
—
6027156
—
VA
Enumeration date
11/08/2005
Last updated
08/11/2011
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