Provider Demographics
NPI:1841794492
Name:KOLODYCHUK, NICHOLAS LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:LEONARD
Last Name:KOLODYCHUK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2663
Mailing Address - Fax:614-293-2053
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-293-2663
Practice Address - Fax:614-293-2053
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY323537-01207X00000X
OH35.151126207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery