Provider Demographics
NPI:1154580827
Name:WARYCHA, BOHDAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:J
Last Name:WARYCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TURNPIKE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-598-7246
Mailing Address - Fax:203-598-0200
Practice Address - Street 1:1579 STRAITS TPKE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-598-7246
Practice Address - Fax:203-598-0200
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0477522081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013362500Medicaid
FL145UZ/33345OtherBCBS
FL145UZ/33345OtherBCBS