1033320551 NPI number — LJUBISA M. STANKOVIC, M.D., PC

Table of content: (NPI 1033320551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033320551 NPI number — LJUBISA M. STANKOVIC, M.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LJUBISA M. STANKOVIC, M.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033320551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
797 POPLAR CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17011-2314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-763-4383
Provider Business Mailing Address Fax Number:
717-763-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
797 POPLAR CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-763-4383
Provider Business Practice Location Address Fax Number:
717-763-4953
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STANKOVIC
Authorized Official First Name:
LJUBISA
Authorized Official Middle Name:
MIHAJLO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-763-4383

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD037459L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 443111398 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MD037459L . This is a "STATE LICENCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50002585 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007440400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ST025763 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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