1871670844 NPI number — DR. DANIJELA S ZOTOVIC MD - INT MED & OPTHA

Table of content: DR. DANIJELA S ZOTOVIC MD - INT MED & OPTHA (NPI 1871670844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871670844 NPI number — DR. DANIJELA S ZOTOVIC MD - INT MED & OPTHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOTOVIC
Provider First Name:
DANIJELA
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD - INT MED & OPTHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871670844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29802-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-648-7888
Provider Business Mailing Address Fax Number:
803-648-3302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
AIKEN INTERNAL MED PA STE 2500
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-6810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-648-7888
Provider Business Practice Location Address Fax Number:
803-648-3302
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  20884 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 20884 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110188630 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 208849 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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