Provider Demographics
NPI:1821231887
Name:RODIC, NEMANJA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:NEMANJA
Middle Name:
Last Name:RODIC
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 38TH ST NW
Mailing Address - Street 2:APT#303
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2922
Mailing Address - Country:US
Mailing Address - Phone:352-256-5728
Mailing Address - Fax:
Practice Address - Street 1:3605 38TH ST NW
Practice Address - Street 2:APT#303
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2922
Practice Address - Country:US
Practice Address - Phone:352-256-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131600207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021443800Medicaid