Provider Demographics
NPI:1568458453
Name:PAPADOPOULOS, DEMETRIOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:A
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 1:1230B HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3251
Mailing Address - Country:US
Mailing Address - Phone:843-284-8359
Mailing Address - Fax:843-284-8359
Practice Address - Street 1:1230B HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3251
Practice Address - Country:US
Practice Address - Phone:843-284-8359
Practice Address - Fax:843-284-8359
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8750171100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00727219OtherRAILROAD MEDICARE ID-RSFPP
SC087505Medicaid
SCD179386795Medicare UPIN
SC1497874424Medicare PIN
SC087505Medicaid
SCD179389223Medicare PIN
SCD179387197Medicare UPIN
SC1093732869Medicare PIN
SCP00727219OtherRAILROAD MEDICARE ID-RSFPP