Healthcare Provider Details

I. General information

NPI: 1215939483
Provider Name (Legal Business Name): SEVERIN BOHDAN PALYDOWYCZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 ROUTE 6 AND 209 STE 1
MILFORD PA
18337-9490
US

IV. Provider business mailing address

396 ROUTE 6 AND 209 STE 1
MILFORD PA
18337-9490
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-9696
  • Fax: 570-409-0316
Mailing address:
  • Phone: 570-296-9696
  • Fax: 570-409-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number191941-1
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: