Provider Demographics
NPI:1942526660
Name:JANICIJEVIC, BORA (MD)
Entity Type:Individual
Prefix:DR
First Name:BORA
Middle Name:
Last Name:JANICIJEVIC
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 1:1691 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1643
Mailing Address - Country:US
Mailing Address - Phone:412-835-6900
Mailing Address - Fax:412-835-6933
Practice Address - Street 1:1691 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1643
Practice Address - Country:US
Practice Address - Phone:412-835-6900
Practice Address - Fax:412-835-6933
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine