Dr. Pavel S. Blagov, Ph.D.
Psychologist, Clinical in Walla Walla, WA. Individual provider (NPI-1).
NPI number1346515541
StatusActive
Last updated in NPPESSep 22, 2018
Details
- NPI
- 1346515541
- Entity type
- Individual (NPI-1)
- Name
- Dr. Pavel S. Blagov
- Credential
- Ph.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 20, 2012
- Last updated
- Sep 22, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL PSYCHOLOGIST
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | PY60236271 | WA | Yes |
Practice location
409 E Sumach StSte 3
Walla Walla, WA 99362-1202
Phone 509-876-1793 · Fax 877-991-1631
Mailing address
885 Hedine RdWalla Walla, WA 99362-8716
Phone 509-876-1793 · Fax 877-991-1631
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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