Provider Demographics
NPI:1053396168
Name:GATARIC, GORDANA (MD)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:GATARIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GORDANA
Other - Middle Name:
Other - Last Name:CUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45435-0001
Mailing Address - Country:US
Mailing Address - Phone:937-245-7100
Mailing Address - Fax:937-245-7999
Practice Address - Street 1:725 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45435-0001
Practice Address - Country:US
Practice Address - Phone:937-245-7200
Practice Address - Fax:937-245-7922
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055293A207R00000X
OH35-090432207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2804451Medicaid
IN200383790AMedicaid
IN200383790AMedicaid
INH78311Medicare UPIN
IN715320DDMedicare ID - Type Unspecified