Provider Demographics
NPI:1760673206
Name:PAVLOVIC, BOJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BOJAN
Middle Name:
Last Name:PAVLOVIC
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 1:11350 MCCORMICK RD.
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:678-841-7123
Mailing Address - Fax:678-841-7135
Practice Address - Street 1:1170 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1458
Practice Address - Country:US
Practice Address - Phone:321-710-8052
Practice Address - Fax:407-599-7246
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089505208VP0014X
IL036.115520208VP0014X
FLME147230208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.115220OtherLICENSE