Provider Demographics
NPI:1114996519
Name:KOLODYCHUK, LEONARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:B
Last Name:KOLODYCHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-733-2092
Mailing Address - Fax:360-733-4013
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-733-4013
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041342207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114996519Medicaid
WA5910198OtherAETNA
WA0230372OtherL&I AND CRIME VICTIMS
WA5447KOOtherREGENCE
WA0230372OtherL&I AND CRIME VICTIMS
WA5910198OtherAETNA