Provider Demographics
NPI:1851455380
Name:BUDIMIROVIC, DEJAN B (MD)
Entity Type:Individual
Prefix:
First Name:DEJAN
Middle Name:B
Last Name:BUDIMIROVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2931 E BIDDLE ST
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3939
Mailing Address - Country:US
Mailing Address - Phone:443-923-1886
Mailing Address - Fax:443-923-1895
Practice Address - Street 1:707 N BROADWAY
Practice Address - Street 2:KENNEDY KRIEGER INSTITUTE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1832
Practice Address - Country:US
Practice Address - Phone:443-923-9400
Practice Address - Fax:443-923-9405
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00608392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64397701OtherCAREFIRST BC BS
G45835Medicare UPIN
MDK631K590Medicare ID - Type Unspecified
MD406532800Medicare ID - Type Unspecified