Basic Information
| Provider Information | |||||||||
| NPI: | 1215939483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALYDOWYCZ | ||||||||
| FirstName: | SEVERIN | ||||||||
| MiddleName: | BOHDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 ROUTE 6 AND 209 | ||||||||
| Address2: | STE 6 | ||||||||
| City: | MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183377615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702969696 | ||||||||
| FaxNumber: | 5704090316 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 ROUTE 6 AND 209 | ||||||||
| Address2: | STE 6 | ||||||||
| City: | MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183377615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702969696 | ||||||||
| FaxNumber: | 5704090316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 191941-1 | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 306039037 | 01 | PA | COALITION | OTHER | 13950 | 01 | PA | GHI/HMO | OTHER | 527007 | 01 | PA | AETNA USHC | OTHER | OX144P | 01 | PA | HIP OF NY | OTHER | 735048 | 01 | PA | PA BLUE SHIELD | OTHER | 9784602 | 01 | PA | CIGNA | OTHER | P378882 | 01 | PA | OXFORD | OTHER | 080558 | 01 | PA | FIRST PRIORITY HEALTH 65 | OTHER | 1124972 | 01 | PA | UHC | OTHER | 177141 | 01 | PA | MVP | OTHER | 70H321 | 01 | PA | NY BLUESHIELD | OTHER | 1404543 | 05 | PA | MEDICAID | 15551 | 01 | PA | GEISINGER | OTHER | 180015253 | 01 | PA | UHC/RAILROAD MEDICARE | OTHER | 01406142 8 | 05 | NY | MEDICAID | 0D5215 | 01 | PA | PHS | OTHER |