Healthcare Provider Details

I. General information

NPI: 1861657975
Provider Name (Legal Business Name): MOSHE BERACHA KOVACHEVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOSA KOVACEVIC M.D.

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 WOODLAWN AVE
EUGENE OR
97403-1887
US

IV. Provider business mailing address

175 W B ST BLDG K2
SPRINGFIELD OR
97477-4575
US

V. Phone/Fax

Practice location:
  • Phone: 718-502-5750
  • Fax:
Mailing address:
  • Phone: 718-502-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61046664
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD28403
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD28403
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: