Healthcare Provider Details

I. General information

NPI: 1376463067
Provider Name (Legal Business Name): PAVEL AKULOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

180 FRIENDSHIP ST APT 516
PROVIDENCE RI
02903-3740
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP07091
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: