Provider Demographics
NPI:1841267093
Name:DEMETRI, GEORGE D (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:DEMETRI
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 1:450 BROOKLINE AVE
Mailing Address - Street 2:DFCI, D1212
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-3985
Mailing Address - Fax:617-632-3408
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DFCI, D1212
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3985
Practice Address - Fax:617-632-3408
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55911207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3121097OtherMASSHEALTH
42730OtherFALLON COMMUNITY HEALTH P
055911OtherTUFTS
E45070DFOtherHPHC
2064098OtherAETNA US HEALTHCARE
5238043OtherCIGNA
E45070DFOtherHPHC
J09232Medicare ID - Type Unspecified