Provider Demographics
NPI:1033153374
Name:BROKETA, GORAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GORAN
Middle Name:
Last Name:BROKETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SMYTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-7007
Mailing Address - Country:US
Mailing Address - Phone:603-624-4366
Mailing Address - Fax:603-629-3217
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7007
Practice Address - Country:US
Practice Address - Phone:603-624-4366
Practice Address - Fax:603-629-3217
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060211L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148570Medicaid
PA0018385800001Medicaid
PA830007394OtherRR MEDICARE PIN
PAGU039777OtherMEDICARE GROUP
PAGU039841OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA047149N8HMedicare PIN
PAGU039777OtherMEDICARE GROUP
PAGU039841OtherMEDICARE GROUP