Provider Demographics
NPI:1508811811
Name:PYLAEVA, OLGA V (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:PYLAEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 TRICOLOR DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6725
Mailing Address - Country:US
Mailing Address - Phone:614-367-6061
Mailing Address - Fax:614-706-5879
Practice Address - Street 1:3617 S OLD 3C HWY
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-9520
Practice Address - Country:US
Practice Address - Phone:614-367-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2439712Medicaid
OHPY4134811Medicare PIN
OHH98132Medicare UPIN