Provider Demographics
NPI:1861752180
Name:MOSTOVYCH, NADIA KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:KATHERINE
Last Name:MOSTOVYCH
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 1:1427 CLARKVIEW RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2100
Mailing Address - Country:US
Mailing Address - Phone:410-296-0414
Mailing Address - Fax:410-296-0412
Practice Address - Street 1:1427 CLARKVIEW RD STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-296-0414
Practice Address - Fax:410-296-0412
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0086288207YX0007X
390200000X
IL036.163781207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program