Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 212775 | MA |
Y | 111NI0900X | Internist | 212775 | MA |
N | 207R00000X | Internist | OP61188829 | WA |
N | 111NI0900X | Internist | OP61188829 | WA |
N | 207RN0300X | Nephrologist | 16087 | NH |
N | 207RN0300X | Nephrologist | 212775 | MA |
NPI | 1063491397 |
---|---|
Provider Name | Demetrius Peter Rizos |
First Address | Danvers, MA 01923-1260 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2182676 | (05) | WA |
3095842 | (05) | NH |