Healthcare Provider Details

I. General information

NPI: 1982376422
Provider Name (Legal Business Name): VICTOR LUKE KULYNYCZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 MADDOX BLVD
CHINCOTEAGUE ISLAND VA
23336-2253
US

IV. Provider business mailing address

12124 E RIDGE RD
PRINCESS ANNE MD
21853-2218
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-5330
  • Fax: 757-336-5355
Mailing address:
  • Phone: 410-726-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2306606018
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: