Provider Demographics
NPI:1053481044
Name:HANNA DEMARCO MD PROF CORP
Entity type:Organization
Organization Name:HANNA DEMARCO MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-436-7377
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-436-7377
Mailing Address - Fax:702-436-7322
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:SUITE 8
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-436-7377
Practice Address - Fax:702-436-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38868Medicare ID - Type Unspecified
NVI02872Medicare UPIN