Provider Demographics
NPI:1518954395
Name:DAMJANOV, NEVENA (MD)
Entity Type:Individual
Prefix:
First Name:NEVENA
Middle Name:
Last Name:DAMJANOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N. 39TH STREET
Mailing Address - Street 2:103A MEDICAL ARTS BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-707-4739
Mailing Address - Fax:215-707-3677
Practice Address - Street 1:51 N. 39TH STREET
Practice Address - Street 2:103A MEDICAL ARTS BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-707-4665
Practice Address - Fax:215-707-2783
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045158L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014837160005Medicaid
F83181Medicare UPIN
PA082717Medicare PIN