Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT191225 | PA |
N | 111NI0900X | Internist | MT191225 | PA |
Y | 207RN0300X | Nephrologist | 277267 | NY |
NPI | 1013176403 |
---|---|
Provider Name | Gordana Obradovic |
First Address | New Hartford, NY 13413-0602 |
Second Address | Syracuse, NY 13212-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 14/10/2016 |