Organization
SELEVERSTOV MEDICAL, P.C.
Active
Other names
Heritage Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
OLEKSANDR SELEVERSTOV MD (OWNER)
(518) 801-6446
Entity
Organization
Contact information
Practice address
56 N COLLEGE AVE UNIT 2A, COLLEGE PLACE, WA 99324-1048
(097) 300-7285
(866) 531-7606
Mailing address
146 THUNDER RIDGE DR, WALLA WALLA, WA 99362-7762
(518) 801-6446
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/02/2023
Last updated
01/29/2025
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