Provider Demographics
NPI:1790874048
Name:MUCKOVA, NATASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:MUCKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5669
Practice Address - Street 1:4545 CORDATA PARKWAY, SUITE 1B
Practice Address - Street 2:GASTROENTEROLOGY
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5669
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 91710207R00000X
MO110389207R00000X
GA63885207RG0100X
WAMD60280545207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine