Lidija Petrovic, MD

Primary specialty

Anatomic Pathology PhysicianTaxonomy code 207ZP0101X

License

A52273 Issued in CA

Practice address

1510 San Pablo St FL 6
Los Angeles, CA 90033-5320

Phone

(323) 442-4815

NPI assigned

Feb 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Consultants for Path & Lab Med Inc, a Medical Group

  • Specialist
  • West Hollywood, CA
  • NPI 1588691414
  NPD (past)
• University Pathology Associates, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Los Angeles, CA
  • NPI 1952325565
  NPD (past)
• New York University Medical Center Pathology Associates

  • Anatomic Pathology & Clinical Pathology Physician
  • Boynton Beach, FL
  • NPI 1811987456
  NPD (past)
• Weill Medical College of Cornell

  • Clinical Medical Laboratory
  • New York, NY
  • NPI 1932203346
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1457326266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-2582",
            "fax_number": "323-442-2588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 SAN PABLO ST FL 6",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335320",
            "telephone_number": "323-442-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROVIC",
        "first_name": "LIDIJA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "NY",
            "license": "226218",
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "CA",
            "license": "A52273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE SHIELD #",
            "identifier": "ZZZ54738Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE SHIELD #",
            "identifier": "ZZZ94714Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE #",
            "identifier": "W7801B",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID #",
            "identifier": "GR0101420",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID #",
            "identifier": "LAB28654F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE #",
            "identifier": "HW7801B",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE #",
            "identifier": "HW7801A",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE SHIELD #",
            "identifier": "ZZZ31029Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID #",
            "identifier": "GR0101421",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lusine Petrosyan
• Meri Petrosyan
• Romela Petrosyan, M.D.
• Shushan Petrosyan
• Jelica Petrovic
• Nataly Seka Petrovic, LCSW
• Madalyn Marie Petrovich, M.S., CCC-SLP
• Henrik Petrowsky, MD
• Richard Edward Petrucci Jr., MD
• Bertha Alexis Pettaway, LCSW

• Anatomic Pathology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Anatomic Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.