Provider Demographics
NPI:1619957818
Name:GOSPODNETIC, MARIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIJAN
Middle Name:
Last Name:GOSPODNETIC
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 1:1 PARKWEST CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5551
Mailing Address - Country:US
Mailing Address - Phone:804-320-2483
Mailing Address - Fax:
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:SUITE 5000
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021429OtherAETNA US HEALTHCARE
33514OtherSENTARA
0000010919702OtherUNITED
6206247OtherVA PREMIER
226121OtherANTHEM
329248OtherMAMSI
541941044002OtherTRICARE
1452472OtherCIGNA
94528OtherSOUTHERN HEALTH
11937OtherCARENET
33514OtherOPTIMA HEALTH
541941044002OtherTRICARE