1013989581 NPI number — DR. NENAD B JANICIJEVIC M.D.

Table of content: DR. NENAD B JANICIJEVIC M.D. (NPI 1013989581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013989581 NPI number — DR. NENAD B JANICIJEVIC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANICIJEVIC
Provider First Name:
NENAD
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1013989581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 WASHINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15228-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-835-6900
Provider Business Mailing Address Fax Number:
412-835-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 WASHINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15228-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-835-6900
Provider Business Practice Location Address Fax Number:
412-835-6933
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD021521E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD021521E , 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: 1530211 . This is a "HIGHMARK OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: ME121910 . This is a "HIGHMARK OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 210694500 . This is a "US DEPT OF DISABILITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0681487 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100674 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 228827401 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 700000896 . This is a "PALAMATO GBA RAILROAD MED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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