Healthcare Provider Details

I. General information

NPI: 1508227018
Provider Name (Legal Business Name): MILAN RADOVANOVIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date: 10/21/2016
Reactivation Date: 01/11/2017

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-0001
US

IV. Provider business mailing address

PO BOX 810
HANOVER NH
03755-0810
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax: 603-640-1228
Mailing address:
  • Phone: 603-308-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24190
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number70986
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: