Provider Demographics
NPI:1417940818
Name:PAPADOURIS, DIMITRIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:
Last Name:PAPADOURIS
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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203
Mailing Address - Country:US
Mailing Address - Phone:877-845-9689
Mailing Address - Fax:301-668-1742
Practice Address - Street 1:8001 FORBES PL
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2208
Practice Address - Country:US
Practice Address - Phone:703-824-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2203162085R0202X, 2085R0204X
VA1012393862085R0202X
VA01012393862085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2059631Medicaid
MA68222OtherCHILDREN'S MEDICAL
DC038104200Medicaid
MA971090OtherNETWORK HEALTH PLAN
MA90530OtherFALLON
MA2236708OtherFIRST HEALTH
NH30204331OtherNH MEDICAID
MAAA14486OtherHARVARD PILGRIM HEALTH CA
MAP00166139OtherRAIL ROAD MEDICARE
MA5540285OtherFIRST HEALTH CCN
MAJ26090OtherBLUE CROSS/BLUE SHIELD
MA123003OtherAETNA/US HEALTHCARE
MA469507OtherTUFTS HEALTH PLAN
MA4931751OtherCIGNA
MA68222OtherHEALTHY START
MAA37109OtherMEDICARE
NH01Y007671NH01OtherNH BLUE SHIELD
MA68222OtherHEALTHY START
MA2236708OtherFIRST HEALTH
MA4931751OtherCIGNA