Provider Demographics
NPI:1891033676
Name:NADAZDIN BOSKOVIC, OGNJENKA (MD)
Entity Type:Individual
Prefix:DR
First Name:OGNJENKA
Middle Name:
Last Name:NADAZDIN BOSKOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2712
Mailing Address - Country:US
Mailing Address - Phone:860-696-2350
Mailing Address - Fax:860-724-4443
Practice Address - Street 1:1559 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2712
Practice Address - Country:US
Practice Address - Phone:860-696-2350
Practice Address - Fax:860-724-4443
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine