MEDICARE: DR. NICHOLAS GREGORY PEJIC 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
1	2084P0800X	Psychiatry Physician	200771	LA

General Provider Information

NPI Number	:	1952594822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS GREGORY PEJIC M.D.

Provider Business Mailing Address
First Line	:	1301 ANTONINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-3601
Country	:	US
Telephone Number	:	504-899-1682
Fax Number	:	504-265-9393

Provider Business Practice Location Address
First Line	:	1301 ANTONINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-3601
Country	:	US
Telephone Number	:	504-899-1682
Fax Number	:	504-265-9393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	05/11/2014

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