Provider Demographics
NPI:1669542668
Name:NAUMOVICH, ANNA D (MD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:D
Last Name:NAUMOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:DARREN
Other - Last Name:WARSZEWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5205 SOUTH GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111
Mailing Address - Country:US
Mailing Address - Phone:314-481-7977
Mailing Address - Fax:314-481-4420
Practice Address - Street 1:5205 SOUTH GRAND AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111
Practice Address - Country:US
Practice Address - Phone:314-481-7977
Practice Address - Fax:314-481-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202535209Medicaid
MO110023391OtherRAILROAD MEDICARE
MO990001459Medicare PIN
A10747Medicare UPIN