Individual
KEVIN RICHARD DMYTRIW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
524 SOUTHPARK BOULEVARD, JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC, COLONIAL HEIGHTS, VA 23834
(804) 504-7980
(804) 504-7991
Mailing address
524 SOUTHPARK BOULEVARD, JENCARE NEIGHBORHOOD MEDICAL SOUTH PARK, LLC, COLONIAL HEIGHTS, VA 23834
(804) 504-7980
(804) 504-7991
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
33539
NJ
Other
Enumeration date
05/28/2005
Last updated
08/14/2014
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