Provider Demographics
NPI:1891797502
Name:KARIDES, DEMETRIOS (MD)
Entity type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:
Last Name:KARIDES
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 1:14 SOUNDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1114
Mailing Address - Country:US
Mailing Address - Phone:718-204-7821
Mailing Address - Fax:
Practice Address - Street 1:14 SOUNDVIEW DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1114
Practice Address - Country:US
Practice Address - Phone:718-204-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-09-27
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NY2106352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258088Medicaid
05570GMedicare ID - Type Unspecified
NY02258088Medicaid