Provider Demographics
NPI:1013176403
Name:OBRADOVIC, GORDANA (MD)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:OBRADOVIC
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:PO BOX 602
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0602
Mailing Address - Country:US
Mailing Address - Phone:315-624-9000
Mailing Address - Fax:315-624-9003
Practice Address - Street 1:1304 BUCKLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4311
Practice Address - Country:US
Practice Address - Phone:315-478-3311
Practice Address - Fax:315-476-5211
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT191225207R00000X
NY277267207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine