Mladen Kolovrat, PA
Individual provider Active NPI Physician Assistant · Exeter, NH
NPI 1487947875 · NPPES record last updated Jan 25, 2017
Key facts
- NPI
- 1487947875
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1206 (NH)
- Practice address
- 1 Hampton Rd
Suite 200
Exeter, NH 03833-4848 - Phone
- (603) 775-7575
- Fax
- (603) 778-9680
- NPI assigned
- May 18, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190910001398 | RI | Practitioner - Physician Assistant | 8022263235 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1206 | NH | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Current Care, P.a. | Current |
Accepting new patients | |
| American Current Care P.a. | Current |
Accepting new patients | |
| Advanced Chiropractic Life Center, Inc | Past | Accepting new patients |
Locations
290 Branch Ave
Providence, RI 02904
Phone (401) 722-8880
5080 Spectrum Dr
Ste 1200W
Addison, TX 75001
Interoperability endpoints
- mkolovrat@aosm1214.srs-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1206 | NH | Yes |
Addresses
Primary practice location
1 Hampton Rd
Suite 200
Exeter, NH 03833-4848
Mailing address
1 Hampton Rd
Suite 200
Exeter, NH 03833-4848
Phone (603) 775-7575
Other providers in Exeter, NH
- Walter Kelter
- Kensington School District
- John Kepka
- Catherine Kingston
- Hannah Neo Kirby
- Nicholas Koren
- Carol D Krasin
- Joshua Michael Krasnow
- Maria Kuehl
- Andrew F Kunkemueller
All providers in Exeter, NH · Physician Assistant in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.