Provider Demographics
NPI:1013940212
Name:DAMJANOVIC, DUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSAN
Middle Name:
Last Name:DAMJANOVIC
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2025
Practice Address - Country:US
Practice Address - Phone:570-271-6621
Practice Address - Fax:570-271-6762
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428689207L00000X
FLME146198207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1554147OtherGATEWAY-GH
PA101661202Medicaid
PA2732264000OtherAMERIHEALTH 65 PA-GH
PA50067113OtherCAPITAL BLUE CROSS-GH
PA103168OtherGEISINGER-GH
PA1872495OtherHIGHMARK BLUE SHIELD-GH
PA20054402OtherAMERIHEALTH MERCY-GH
PA103168OtherGEISINGER-GH
I56198Medicare UPIN