MEDICARE: DR. COLIN MYCHAK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	202103319	NC
2	207Q00000X	Family Medicine Physician	H0100176	MD

General Provider Information

NPI Number	:	1619327954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN MYCHAK D.O.

Provider Business Mailing Address
First Line	:	201 DEFENSE HWY STE 205
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7096
Country	:	US
Telephone Number	:	855-527-7246
Fax Number	:	866-229-5063

Provider Business Practice Location Address
First Line	:	57 HOWARD GAP RD
Second Line	:
City	:	FLETCHER
State	:	NC
Zip	:	28732-9560
Country	:	US
Telephone Number	:	828-483-4330
Fax Number	:	828-483-5417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	01/02/2025

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