Provider Demographics
NPI:1215939483
Name:PALYDOWYCZ, SEVERIN BOHDAN (MD)
Entity type:Individual
Prefix:
First Name:SEVERIN
Middle Name:BOHDAN
Last Name:PALYDOWYCZ
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 1:396 ROUTE 6 AND 209 STE 1
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9490
Mailing Address - Country:US
Mailing Address - Phone:570-296-9696
Mailing Address - Fax:570-409-0316
Practice Address - Street 1:396 ROUTE 6 AND 209 STE 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9490
Practice Address - Country:US
Practice Address - Phone:570-296-9696
Practice Address - Fax:570-409-0316
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA191941-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA306039037OtherCOALITION
PA13950OtherGHI/HMO
PAOX144POtherHIP OF NY
PA180015253OtherUHC/RAILROAD MEDICARE
PA735048OtherPA BLUE SHIELD
NY01406142 8Medicaid
PA080558OtherFIRST PRIORITY HEALTH 65
PA527007OtherAETNA USHC
PA0D5215OtherPHS
PA1404543Medicaid
PA177141OtherMVP
PA1124972OtherUHC
PA15551OtherGEISINGER
PA70H321OtherNY BLUESHIELD
PA9784602OtherCIGNA
PAP378882OtherOXFORD
NY01406142 8Medicaid
PA70H321OtherNY BLUESHIELD
PA306039037OtherCOALITION