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General NPI Number Information
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NPI Number | 1780846444
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Entity Type | Individual
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Provider Name | DMITRI KOLYCHEV M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 3378 W. MARKET ST SUITE A
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City | FAIRLAWN
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State | OH
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Zip | 44333
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Country | US
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Telephone | 330-576-3500
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Fax | 234-312-2405
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Provider Business Mailing Address
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Address Line | 3378 W MARKET ST STE A
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City | FAIRLAWN
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State | OH
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Zip | 44333-3306
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Country | US
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Telephone | 330-576-3500
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Fax | 234-312-2405
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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 | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 2013-01645
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 2013-01645
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License Number State | NC
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