Provider Demographics
NPI:1972578250
Name:KAZAKIS, DEMETRIOS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:JAMES
Last Name:KAZAKIS
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1708 OLD DONATION PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3064
Practice Address - Country:US
Practice Address - Phone:757-395-5300
Practice Address - Fax:757-395-5322
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051280207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA35082OtherOPTIMA/SENTARA
VAPAROtherVPH
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA006010326Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherAETNA PPO
VAPAROtherMULTIPLAN
VA-001OtherCHAMPUS/TRICARE
VA006016782Medicaid
VA250369OtherATHEM BC/BS VA/HK
VA054974OtherANTHEM BCBS
VA15792OtherSENTARA OHP/SHP
NC0604IOtherBCBS
VAPAROtherCIGNA
VA263654OtherUHC/MAMSI/MDIPA
NC890604IMedicaid
VAPAROtherVHN/PHCS
VAPAROtherUSA MANAGED CARE
VA35082OtherOPTIMA/SENTARA
VA263654OtherUHC/MAMSI/MDIPA
VAPAROtherVHN/PHCS
VAPAROtherAETNA PPO
VAF83317Medicare UPIN