Provider Demographics
NPI:1720017080
Name:CONOVALCIUC, PAVEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:CONOVALCIUC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 E CLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-8759
Mailing Address - Country:US
Mailing Address - Phone:509-368-7790
Mailing Address - Fax:
Practice Address - Street 1:1502 N VERCLER RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1078
Practice Address - Country:US
Practice Address - Phone:509-444-8204
Practice Address - Fax:509-434-0321
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB11720Medicare ID - Type Unspecified