Provider Demographics
NPI:1285075069
Name:ERNEST UZICANIN MD, PC
Entity type:Organization
Organization Name:ERNEST UZICANIN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:UZICANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-745-3695
Mailing Address - Street 1:19236 MEADOW VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2924
Mailing Address - Country:US
Mailing Address - Phone:301-745-3695
Mailing Address - Fax:301-745-4572
Practice Address - Street 1:19236 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2924
Practice Address - Country:US
Practice Address - Phone:301-745-3695
Practice Address - Fax:301-745-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
68550001OtherFEDERAL BCBS
MD080103436OtherRAILROAD MEDICARE
MD359QOtherMEDICARE ID
0U04OtherBCBS
MD359QOtherMEDICARE ID