Provider Demographics
NPI:1528285467
Name:YAKIREVICH, EVGENY
Entity type:Individual
Prefix:
First Name:EVGENY
Middle Name:
Last Name:YAKIREVICH
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 1:593 EDDY ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY RIH APC 12
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5057
Mailing Address - Fax:401-444-8514
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY RIH APC 12
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5057
Practice Address - Fax:401-444-8514
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12596207ZP0101X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology