Provider Demographics
NPI:1750569349
Name:HARRY KOLODNER MD
Entity type:Organization
Organization Name:HARRY KOLODNER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-786-0906
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-0987
Mailing Address - Country:US
Mailing Address - Phone:727-786-0906
Mailing Address - Fax:727-781-4788
Practice Address - Street 1:33920 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2654
Practice Address - Country:US
Practice Address - Phone:727-786-0906
Practice Address - Fax:727-781-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33861332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME33861OtherFLORIDA MEDICAL LICENSE
FL038877700Medicaid
D21458Medicare UPIN
30168Medicare PIN
0489040001Medicare NSC