Provider Demographics
NPI:1891911954
Name:PETRINJAC-NENADIC, RADA (MD)
Entity type:Individual
Prefix:DR
First Name:RADA
Middle Name:
Last Name:PETRINJAC-NENADIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000 DEPT 479
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-820-0141
Mailing Address - Fax:901-820-0144
Practice Address - Street 1:5100 SANDERLIN AVE
Practice Address - Street 2:SUITE 2100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4387
Practice Address - Country:US
Practice Address - Phone:901-820-0141
Practice Address - Fax:901-820-0144
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000430682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001574Medicare PIN