Provider Demographics
NPI:1427846971
Name:CHERNOUSOV, ALEKSANDR P
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:P
Last Name:CHERNOUSOV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 SW GEM LN APT 804
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1363
Mailing Address - Country:US
Mailing Address - Phone:971-363-5155
Mailing Address - Fax:
Practice Address - Street 1:12520 SW GEM LN APT 804
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1363
Practice Address - Country:US
Practice Address - Phone:971-363-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112734171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty