Provider Demographics
NPI:1063491397
Name:RIZOS, DEMETRIUS PETER (DO)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:PETER
Last Name:RIZOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1260
Mailing Address - Country:US
Mailing Address - Phone:978-319-1867
Mailing Address - Fax:
Practice Address - Street 1:125 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6002
Practice Address - Country:US
Practice Address - Phone:207-661-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2727207RN0300X, 208M00000X
MA212775207RN0300X, 207R00000X
NH25412207RN0300X, 207R00000X
WAOP61188829207R00000X
OH34C.000067207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2182676Medicaid
NH3095842Medicaid
MAS400114900Medicare PIN
MAS400114902Medicare PIN
NHT400163773Medicare PIN
MAS400123308Medicare PIN
MAS400166843Medicare PIN
NHT400141611Medicare PIN
NHT400148805Medicare PIN