Provider Demographics
NPI:1982376422
Name:KULYNYCZ, VICTOR LUKE
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:LUKE
Last Name:KULYNYCZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-2218
Mailing Address - Country:US
Mailing Address - Phone:410-726-1567
Mailing Address - Fax:
Practice Address - Street 1:6751 MADDOX BLVD
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE ISLAND
Practice Address - State:VA
Practice Address - Zip Code:23336-2253
Practice Address - Country:US
Practice Address - Phone:757-336-5330
Practice Address - Fax:757-336-5355
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606018208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation