Provider Demographics
NPI:1013996404
Name:PAPADOPOULOS, DIMITRIOS P (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:P
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 1:45 READE PLACE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-454-2372
Mailing Address - Fax:845-437-3123
Practice Address - Street 1:111 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5852
Practice Address - Country:US
Practice Address - Phone:845-339-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1881092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01348118Medicaid
NYP672354OtherOXFORD LIBERTY
NY000470812001OtherBCBS NE NY
NY10642OtherGHI HMO
NY30K061OtherEMPIRE BCBS
NY7299684OtherGHI PPO
NY000470812002OtherBCBS NE NY
NY10039815OtherCDPHP
NY2330132OtherAETNA USHC HMO
NYP673936OtherOXFORD FREEDOM
NY397115OtherMVP
NY4112605OtherAETNA USHC PPO
NY930721OtherEMPIRE BCBS
NY2330133OtherAETNA USHC HMO
NY397004OtherMVP
NY4000061OtherGHI
NY397115OtherMVP
NY10642OtherGHI HMO
NY397004OtherMVP
NY4000061OtherGHI