Healthcare Provider Details

I. General information

NPI: 1861752180
Provider Name (Legal Business Name): NADIA KATHERINE MOSTOVYCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 NW LABICHE LN STE 130
BEND OR
97703-6748
US

IV. Provider business mailing address

2220 NW LABICHE LN STE 130
BEND OR
97703-6748
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-2026
  • Fax: 541-721-5402
Mailing address:
  • Phone: 541-728-2026
  • Fax: 541-721-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD214500
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: