Provider Demographics
NPI:1649239153
Name:ROMANIC, BRANISLAV S (MD)
Entity Type:Individual
Prefix:MR
First Name:BRANISLAV
Middle Name:S
Last Name:ROMANIC
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 1:7115 GUILFORD DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5236
Mailing Address - Country:US
Mailing Address - Phone:301-663-9570
Mailing Address - Fax:301-663-9571
Practice Address - Street 1:7115 GUILFORD DR STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704
Practice Address - Country:US
Practice Address - Phone:301-663-9570
Practice Address - Fax:301-663-9571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060764207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG53026Medicare UPIN
G53026Medicare UPIN