Provider Demographics
NPI:1235142951
Name:PAPADOPOULOS, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:PAPADOPOULOS
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 1:612 W DUARTE RD
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7602
Mailing Address - Country:US
Mailing Address - Phone:626-446-4645
Mailing Address - Fax:626-446-1626
Practice Address - Street 1:612 W DUARTE RD
Practice Address - Street 2:SUITE 602
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7602
Practice Address - Country:US
Practice Address - Phone:626-446-4645
Practice Address - Fax:626-446-1626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57027208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00570270Medicaid
CAA53221Medicare UPIN
CA00570270Medicaid