Provider Demographics
NPI:1992769400
Name:HATZIVLASSIOU, DIMITRIOS (MD, PHD)
Entity type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:
Last Name:HATZIVLASSIOU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S HWY 27
Mailing Address - Street 2:SUITE 4309
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6816
Mailing Address - Country:US
Mailing Address - Phone:352-353-0557
Mailing Address - Fax:
Practice Address - Street 1:2400 S HWY 27
Practice Address - Street 2:SUITE 4309
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6816
Practice Address - Country:US
Practice Address - Phone:352-353-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 842522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03387OtherBLUE CROSS BLUE SHIELD #
FL267232400Medicaid
BH7645293OtherDEA #
BH7645293OtherDEA #
FLH91388Medicare UPIN