Provider Demographics
NPI:1457490963
Name:MARKOUIZOS, DEMETRIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:
Last Name:MARKOUIZOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3809
Mailing Address - Country:US
Mailing Address - Phone:718-278-9500
Mailing Address - Fax:718-278-2430
Practice Address - Street 1:3014 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3809
Practice Address - Country:US
Practice Address - Phone:718-278-9500
Practice Address - Fax:718-278-2430
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1708282080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01052079Medicaid