Provider Demographics
NPI:1457347015
Name:NEDELJKOVIC, SRDJAN S (MD)
Entity Type:Individual
Prefix:
First Name:SRDJAN
Middle Name:S
Last Name:NEDELJKOVIC
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY CMP2
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-789-2777
Mailing Address - Fax:617-234-6384
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY CMP2
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-2777
Practice Address - Fax:617-234-6384
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-12-03
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Provider Licenses
StateLicense IDTaxonomies
MA60559207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205027Medicaid
MA3015512Medicaid
F30921Medicare UPIN
MA3015512Medicaid