Basic Information
| Provider Information | |||||||||
| NPI: | 1013996404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAPADOPOULOS | ||||||||
| FirstName: | DIMITRIOS | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 45 READE PLACE | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454542372 | ||||||||
| FaxNumber: | 8454373123 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MARYS AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124015852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453397700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 188109 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 01348118 | 05 | NY | MEDICAID | P672354 | 01 | NY | OXFORD LIBERTY | OTHER | 000470812001 | 01 | NY | BCBS NE NY | OTHER | 10642 | 01 | NY | GHI HMO | OTHER | 30K061 | 01 | NY | EMPIRE BCBS | OTHER | 7299684 | 01 | NY | GHI PPO | OTHER | 000470812002 | 01 | NY | BCBS NE NY | OTHER | 10039815 | 01 | NY | CDPHP | OTHER | 2330132 | 01 | NY | AETNA USHC HMO | OTHER | P673936 | 01 | NY | OXFORD FREEDOM | OTHER | 397115 | 01 | NY | MVP | OTHER | 4112605 | 01 | NY | AETNA USHC PPO | OTHER | 930721 | 01 | NY | EMPIRE BCBS | OTHER | 2330133 | 01 | NY | AETNA USHC HMO | OTHER | 397004 | 01 | NY | MVP | OTHER | 4000061 | 01 | NY | GHI | OTHER |