Provider Demographics
NPI:1003992926
Name:KOUMANIS, DIMITRI J (MD)
Entity Type:Individual
Prefix:MR
First Name:DIMITRI
Middle Name:J
Last Name:KOUMANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13 CHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4432
Mailing Address - Country:US
Mailing Address - Phone:518-203-2593
Mailing Address - Fax:518-314-0701
Practice Address - Street 1:13 CHESTER STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4432
Practice Address - Country:US
Practice Address - Phone:518-203-2593
Practice Address - Fax:518-314-0701
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0027332086S0122X
NY256948208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery