Provider Demographics
NPI:1053350363
Name:DEMARO, THOMAS J (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:DEMARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-3115
Mailing Address - Country:US
Mailing Address - Phone:561-334-3774
Mailing Address - Fax:
Practice Address - Street 1:5823 APPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-3115
Practice Address - Country:US
Practice Address - Phone:561-334-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18271207P00000X
TN1927207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935562Medicaid
AL051532977DEMMedicare ID - Type Unspecified
AL009935562Medicaid