Provider Demographics
NPI:1407830607
Name:KOLYCIUS, RITA JUDITA (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:JUDITA
Last Name:KOLYCIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:KOLYCIUS
Other - Last Name:RALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4991 LAKE BROOK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9290
Mailing Address - Country:US
Mailing Address - Phone:888-627-4702
Mailing Address - Fax:240-364-2539
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:NICU
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:301-279-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD037463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics