Provider Demographics
NPI:1871535245
Name:DEMONACO, NICHOLAS A (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:DEMONACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-868-7911
Mailing Address - Fax:301-868-2285
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-868-7911
Practice Address - Fax:301-868-2285
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0064234207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
207902OtherPRIORITY PARTNERS
MD1275875OtherAETNA HMO
DCB6480007OtherBC/BS OF DC
DC037962600Medicaid
MD88980302OtherBC/BS MD - GREENBELT
7699813OtherCIGNA
DC02810008OtherBC/BS OF DC
MD88980301OtherBC/BS MD - CLINTON
MD2148054OtherALLIANCE
2148054OtherMAMSI
268006OtherANTHEM BS - CLINTON
MD268044OtherANTHEM BS - GREENBELT
MD412404900Medicaid
019461O50Medicare PIN
MD88980301OtherBC/BS MD - CLINTON
DCB6480007OtherBC/BS OF DC
P00381934Medicare PIN