Individual
DR. DMITRI KOLYCHEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3378 W. MARKET ST, SUITE A, FAIRLAWN, OH 44333
(330) 576-3500
(234) 312-2405
Mailing address
3378 W MARKET ST STE A, FAIRLAWN, OH 44333-3306
(330) 576-3500
(234) 312-2405
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2013-01645
NC
2084V0102X
Vascular Neurology Physician
2013-01645
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780846444
—
NC
01
—
1809Y
BCBS NC
NC
Enumeration date
06/25/2008
Last updated
03/05/2020
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