MEDICARE: VICTOR LUKE KULYNYCZ

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	208100000X	Physical Medicine & Rehabilitation Physician	2306606018	VA

General Provider Information

NPI Number	:	1982376422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR LUKE KULYNYCZ

Provider Business Mailing Address
First Line	:	12124 E RIDGE RD
Second Line	:
City	:	PRINCESS ANNE
State	:	MD
Zip	:	21853-2218
Country	:	US
Telephone Number	:	410-726-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	6751 MADDOX BLVD
Second Line	:
City	:	CHINCOTEAGUE ISLAND
State	:	VA
Zip	:	23336-2253
Country	:	US
Telephone Number	:	757-336-5330
Fax Number	:	757-336-5355

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

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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