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NPI Code Detail

MEDICARE: DR. MARKO IVANCICH M.D.

MEDICARE: DR. MARKO IVANCICH M.D.
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
12084P0800XPsychiatry Physician2025-02692NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1I152-5579-6049-07OTHERWIDRIVERS LICENSE

General Provider Information

NPI Number : 1336836915
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARKO IVANCICH M.D.
Provider Business Mailing Address
First Line : 1638 OWEN DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3424
Country : US
Telephone Number : 910-615-3333
Fax Number :
Provider Business Practice Location Address
First Line : 1638 OWEN DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3424
Country : US
Telephone Number : 910-615-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2023
Last Update Date : 05/11/2026

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