Provider Demographics
NPI:1780848820
Name:EBSWORTH-MOJICA, KATHERINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:EBSWORTH-MOJICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CUMBERLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1385
Mailing Address - Country:US
Mailing Address - Phone:606-248-3015
Mailing Address - Fax:
Practice Address - Street 1:2004 CUMBERLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1385
Practice Address - Country:US
Practice Address - Phone:606-248-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY518292080P0208X, 208000000X
FLME1296032080P0208X
NY271472208000000X
PR18151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100540920Medicaid