Provider Demographics
NPI:1205602364
Name:VOLCHKOVA, KARINA VLADISLAVOVNA
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:VLADISLAVOVNA
Last Name:VOLCHKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6810
Mailing Address - Country:US
Mailing Address - Phone:425-301-0412
Mailing Address - Fax:
Practice Address - Street 1:3800 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1928
Practice Address - Country:US
Practice Address - Phone:315-552-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030906363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical