Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 161003 | MA |
N | 111NI0900X | Internist | 161003 | MA |
N | 207RC0000X | Internist - Cardiovascular Disease | 161003 | MA |
Y | 207RI0011X | Interventional Cardiology | 161003 | MA |
NPI | 1013975622 |
---|---|
Provider Name | Zoran S. Nedeljkovic |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 23/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110036744A | (05) | MA |