Provider Demographics
NPI:1386464931
Name:GERASIMCHUK, PAVEL I
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:I
Last Name:GERASIMCHUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19511 E MICAVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9643
Mailing Address - Country:US
Mailing Address - Phone:509-499-2737
Mailing Address - Fax:
Practice Address - Street 1:19511 E MICAVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016-9643
Practice Address - Country:US
Practice Address - Phone:509-499-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11889171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter