Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD470194 | PA |
Y | 111NI0900X | Internist | MD470194 | PA |
NPI | 1003355991 |
---|---|
Provider Name | Dr. Ivan Cvorovic |
First Address | Belgrade, BELGRADE 11000 |
Second Address | Scranton, PA 18505-3814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2017 |
Last Update Date | 10/12/2020 |