Healthcare Provider Details

I. General information

NPI: 1417940818
Provider Name (Legal Business Name): DIMITRIOS CONSTANTINOS PAPADOURIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FORBES PL SUITE 103
SPRINGFIELD VA
22151-2208
US

IV. Provider business mailing address

PO BOX 658
BALTIMORE MD
21203
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-3200
  • Fax:
Mailing address:
  • Phone: 877-845-9689
  • Fax: 301-668-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number220316
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number101239386
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number220316
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101239386
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: