Provider Demographics
NPI:1891803227
Name:MUTABDZIC, MARIJA DRAGICA (MD)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:DRAGICA
Last Name:MUTABDZIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIJA
Other - Middle Name:DRAGICA
Other - Last Name:ZOVKIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4100
Mailing Address - Country:US
Mailing Address - Phone:315-216-6995
Mailing Address - Fax:
Practice Address - Street 1:98 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1254
Practice Address - Country:US
Practice Address - Phone:315-326-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2604282084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry