Provider Demographics
NPI:1275631632
Name:DIMITRIOU, STEVEN G (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:DIMITRIOU
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 1:227 N BROAD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1503
Mailing Address - Country:US
Mailing Address - Phone:215-762-7785
Mailing Address - Fax:215-568-6007
Practice Address - Street 1:227 N BROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1503
Practice Address - Country:US
Practice Address - Phone:215-762-7785
Practice Address - Fax:215-568-6007
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05012385207RN0300X
PAOS012385207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015712120001Medicaid
PA100560FHFMedicare ID - Type Unspecified
PA1015712120001Medicaid