Marija Dragica Mutabdzic, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

260428 Issued in NY

Practice address

98 N 2ND St
Fulton, NY 13069-1254

Phone

(315) 326-3555

NPI assigned

Aug 27, 2006

Last updated

Jul 1, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marija Dragica Zovkic Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marija.mutabdzic.p1@direct.liberty-resources.nextgenshare.com

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

• Liberty Resources Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Syracuse, NY
  • NPI 1225254881
  NPD
• Liberty Resources, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fulton, NY
  • NPI 1700688827
  NPD

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1891803227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 COUNTRY LN",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131264100",
            "telephone_number": "315-216-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 N 2ND ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691254",
            "telephone_number": "315-326-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTABDZIC",
        "first_name": "MARIJA",
        "middle_name": "DRAGICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-27",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NY",
            "license": "260428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIJA",
            "last_name": "ZOVKIC",
            "middle_name": "DRAGICA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hannah Grace Moore
• Hannah Mudge
• Dennis Mullaney, MD
• Dina Marie Munger, LPN
• Heather Sue Murphy, RN
• Cathy Storrs Nagel, LPN
• Debra Marie Naioti, LPN
• Mary Nateo
• Thuy VI T Nguyen, PHARMD
• Patrick J. Nicholson, D.C.

• Child & Adolescent Psychiatry Physician in Fulton, NY
• Providers in Fulton, NY by specialty
• Child & Adolescent Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.