Provider Demographics
NPI:1821208414
Name:MILJKOVIC, MARKO ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARKO
Middle Name:ADAM
Last Name:MILJKOVIC
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 1:1440 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8908
Mailing Address - Country:US
Mailing Address - Phone:717-566-6670
Mailing Address - Fax:
Practice Address - Street 1:1440 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8908
Practice Address - Country:US
Practice Address - Phone:717-566-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98317207Q00000X
PAMD431006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102199520 0001Medicaid
PA135395ZAA4Medicare PIN
PA135395ZEA5Medicare PIN
PA135395KAGMedicare PIN