Provider Demographics
NPI:1689640245
Name:PAPADOPOULOS, DIMITRIA (DO)
Entity Type:Individual
Prefix:
First Name:DIMITRIA
Middle Name:
Last Name:PAPADOPOULOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3627
Mailing Address - Country:US
Mailing Address - Phone:516-781-5070
Mailing Address - Fax:718-781-5054
Practice Address - Street 1:2351 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3627
Practice Address - Country:US
Practice Address - Phone:516-781-5070
Practice Address - Fax:718-781-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219163207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3K2971Medicare PIN