Provider Demographics
NPI:1932131018
Name:KOLODNER, HARRY (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:KOLODNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33920 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2676
Mailing Address - Country:US
Mailing Address - Phone:727-784-1121
Mailing Address - Fax:727-781-4788
Practice Address - Street 1:33920 US HIGHWAY 19N
Practice Address - Street 2:SUITE 275
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2676
Practice Address - Country:US
Practice Address - Phone:727-784-1121
Practice Address - Fax:727-781-4788
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33861207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME33861OtherMEDICAL LICENSE NUMBER
FL038877700Medicaid
FLD21458Medicare UPIN
FL038877700Medicaid