Basic Information
| Provider Information | |||||||||
| NPI: | 1417940818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAPADOURIS | ||||||||
| FirstName: | DIMITRIOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778459689 | ||||||||
| FaxNumber: | 3016681742 | ||||||||
| Practice Location | |||||||||
| Address1: | 8001 FORBES PL | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221512208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038243200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 220316 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 220316 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | 101239386 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 0101239386 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2059631 | 05 | MA | MEDICAID | 68222 | 01 | MA | CHILDREN'S MEDICAL | OTHER | 038104200 | 05 | DC | MEDICAID | 971090 | 01 | MA | NETWORK HEALTH PLAN | OTHER | 90530 | 01 | MA | FALLON | OTHER | 2236708 | 01 | MA | FIRST HEALTH | OTHER | 30204331 | 01 | NH | NH MEDICAID | OTHER | AA14486 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | P00166139 | 01 | MA | RAIL ROAD MEDICARE | OTHER | 5540285 | 01 | MA | FIRST HEALTH CCN | OTHER | J26090 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER | 123003 | 01 | MA | AETNA/US HEALTHCARE | OTHER | 469507 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 4931751 | 01 | MA | CIGNA | OTHER | 68222 | 01 | MA | HEALTHY START | OTHER | A37109 | 01 | MA | MEDICARE | OTHER | 01Y007671NH01 | 01 | NH | NH BLUE SHIELD | OTHER |