Provider Demographics
NPI:1043212269
Name:MOSTOVYCH, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MOSTOVYCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:STE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4735
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:1824 KING ST
Practice Address - Street 2:STE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4735
Practice Address - Country:US
Practice Address - Phone:904-384-3343
Practice Address - Fax:904-400-6671
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME70190208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250218600Medicaid
780000717OtherMEDICARE RAILROAD
FL28983Medicare PIN
780000717OtherMEDICARE RAILROAD