Provider Demographics
NPI:1841304078
Name:GOLIJANIN, DRAGAN J (MD)
Entity type:Individual
Prefix:
First Name:DRAGAN
Middle Name:J
Last Name:GOLIJANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:195 COLLYER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1869
Mailing Address - Country:US
Mailing Address - Phone:401-272-7799
Mailing Address - Fax:401-272-9299
Practice Address - Street 1:2 DUDLEY ST STE 185
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3247
Practice Address - Country:US
Practice Address - Phone:401-421-0710
Practice Address - Fax:401-444-6947
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD13767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI349005986OtherMEDICARE GROUP PTAN
RIDG86261Medicaid
RI1659463230OtherGROUP NPI