Provider Demographics
NPI:1316270770
Name:GEORGETOWN MEDICAL ASSOCIATE
Entity type:Organization
Organization Name:GEORGETOWN MEDICAL ASSOCIATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAJEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-486-4762
Mailing Address - Street 1:2789 MAPLECREST RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7031
Mailing Address - Country:US
Mailing Address - Phone:260-486-4762
Mailing Address - Fax:260-485-9348
Practice Address - Street 1:2789 MAPLECREST RD STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7031
Practice Address - Country:US
Practice Address - Phone:260-486-4762
Practice Address - Fax:260-485-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000289888OtherANTHEM BCBS
IN200000540CMedicaid
IN194840Medicare PIN
IN200000540CMedicaid