Provider Demographics
NPI:1861657975
Name:BERACHA KOVACHEVICH, MOSHE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:BERACHA KOVACHEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOSA
Other - Middle Name:
Other - Last Name:KOVACEVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:175 W B ST BLDG K2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4575
Mailing Address - Country:US
Mailing Address - Phone:718-502-5750
Mailing Address - Fax:
Practice Address - Street 1:1919 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1887
Practice Address - Country:US
Practice Address - Phone:718-502-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28403208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist