Provider Demographics
NPI:1164084836
Name:DE MARCO, DOMINIC (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:DE MARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOMINIC
Other - Middle Name:GRAYSON
Other - Last Name:DE MARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:3161 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5234
Practice Address - Country:US
Practice Address - Phone:916-878-3495
Practice Address - Fax:916-736-5533
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1567152085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology