Provider Demographics
NPI:1326039223
Name:VUJICIC, RATKO (MD)
Entity Type:Individual
Prefix:DR
First Name:RATKO
Middle Name:
Last Name:VUJICIC
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 1:410 HERLONG AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8350
Mailing Address - Country:US
Mailing Address - Phone:803-909-3600
Mailing Address - Fax:803-909-3800
Practice Address - Street 1:410 HERLONG AVE S STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8350
Practice Address - Country:US
Practice Address - Phone:803-909-3600
Practice Address - Fax:803-909-3800
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25109207LP2900X
NC2006-01101207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3866Medicaid
SCT84209Medicaid
NC2061841Medicaid
SCGP3866Medicaid
AA0146Medicare PIN