Healthcare Provider Details

I. General information

NPI: 1063491397
Provider Name (Legal Business Name): DEMETRIUS PETER RIZOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WASHINGTON ST STE 100
BROOKLINE MA
02446-4579
US

IV. Provider business mailing address

637 WASHINGTON ST STE 100
BROOKLINE MA
02446-4579
US

V. Phone/Fax

Practice location:
  • Phone: 617-798-1600
  • Fax: 617-798-1900
Mailing address:
  • Phone: 617-798-1600
  • Fax: 617-798-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number212775
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number212775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: