Provider Demographics
NPI:1215190186
Name:MILOVANOVIC, MIODRAG
Entity type:Individual
Prefix:MR
First Name:MIODRAG
Middle Name:
Last Name:MILOVANOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 CLIFTON ST.
Mailing Address - Street 2:UNIT 10
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2579
Mailing Address - Country:US
Mailing Address - Phone:617-230-2556
Mailing Address - Fax:
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-893-2003
Practice Address - Fax:781-647-0183
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker