Provider Demographics
NPI:1962421198
Name:CEMERLIC, SENAD (MD)
Entity type:Individual
Prefix:
First Name:SENAD
Middle Name:
Last Name:CEMERLIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PENNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5848
Mailing Address - Country:US
Mailing Address - Phone:302-423-0954
Mailing Address - Fax:
Practice Address - Street 1:1609 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-526-2770
Practice Address - Fax:302-526-2954
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234695207L00000X, 207LA0401X, 207LP2900X, 208VP0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02652257Medicaid
NY0287T1Medicare ID - Type Unspecified
DE021158A97Medicare PIN
NYI28043Medicare UPIN