Provider Demographics
NPI:1811336621
Name:KOUTSOSPYROS, DEMETRI ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRI
Middle Name:ALEXANDER
Last Name:KOUTSOSPYROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEMETRIOS
Other - Middle Name:ALEXANDROS
Other - Last Name:KOUTSOSPYROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 E 210TH ST, BRONX, NY 10467
Mailing Address - Street 2:SAMANTHA RAWANA, DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-6423
Mailing Address - Fax:718-881-2245
Practice Address - Street 1:111 E 210TH ST DEPT OF
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-6423
Practice Address - Fax:718-881-2245
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287315207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine