Provider Demographics
NPI:1013989581
Name:JANICIJEVIC, NENAD B (MD)
Entity Type:Individual
Prefix:DR
First Name:NENAD
Middle Name:B
Last Name:JANICIJEVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021521E207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1530211OtherHIGHMARK OF PA
PAME121910OtherHIGHMARK OF PA
PA210694500OtherUS DEPT OF DISABILITY
PA0681487Medicaid
PA100674OtherUPMC HEALTH PLAN
PA228827401OtherOXFORD
PA700000896OtherPALAMATO GBA RAILROAD MED
PA210694500OtherUS DEPT OF DISABILITY
PA700000896OtherPALAMATO GBA RAILROAD MED