Provider Demographics
NPI:1184604100
Name:MARJANOVIC, DANIELA O (MD)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:O
Last Name:MARJANOVIC
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 1272
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-673-0215
Mailing Address - Fax:541-673-2864
Practice Address - Street 1:2233 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2550
Practice Address - Country:US
Practice Address - Phone:541-673-0215
Practice Address - Fax:641-673-2864
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR225227Medicaid
C93226Medicare UPIN
OR225227Medicaid