Provider Demographics
NPI:1124386156
Name:DRAGICEVIC, NATASA BRATISLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASA
Middle Name:BRATISLAV
Last Name:DRAGICEVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 WOODLAND RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9562
Mailing Address - Country:US
Mailing Address - Phone:707-963-8860
Mailing Address - Fax:707-963-8861
Practice Address - Street 1:6 WOODLAND RD STE 304
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9562
Practice Address - Country:US
Practice Address - Phone:707-963-8860
Practice Address - Fax:707-963-8861
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0570962084N0400X
NV186402084N0400X
CAA1693612084B0040X
NY2866422084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV18640OtherSTATE LICENSE
NV13978464OtherCAQH