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General NPI Number Information
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NPI Number | 1619327954
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Entity Type | Individual
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Provider Name | COLIN MYCHAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 57 HOWARD GAP RD
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City | FLETCHER
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State | NC
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Zip | 28732-9560
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Country | US
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Telephone | 828-483-4330
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Fax | 828-483-5417
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7096
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Country | US
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Telephone | 855-527-7246
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Fax | 866-229-5063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 202103319
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0100176
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License Number State | MD
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