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NPI Code Detail

MEDICARE: DEJAN JELOVAC

MEDICARE: DEJAN JELOVAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA2875MD

General Provider Information

NPI Number : 1245482884
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEJAN JELOVAC
Provider Business Mailing Address
First Line : 7722 HEATHERS LN
Second Line :
City : BALTIMORE
State : MD
Zip : 21236-3836
Country : US
Telephone Number : 410-828-6797
Fax Number :
Provider Business Practice Location Address
First Line : 10015 OLD COLUMBIA RD STE B215
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-1865
Country : US
Telephone Number : 410-356-6161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2008
Last Update Date : 08/26/2009

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