Isaac James Koloditch

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

475 Vine St
Winston Salem, NC 27101-4135

Phone

(941) 761-0409

NPI assigned

Jun 14, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1174191399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 MADISON AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034542",
            "telephone_number": "941-716-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 VINE ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014135",
            "telephone_number": "941-761-0409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODITCH",
        "first_name": "ISAAC",
        "middle_name": "JAMES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lai Chow Kok, MD
• Kathleen Mary Kolaski, MD
• Samuel Joseph Kolb, DO
• Gabrielle Rose Kolesar, PA-C
• Claudia Koliscak
• Sheri Jean Komdeur, ANP
• Neal David Kon, MD
• Sharlene Malia Kona, CRNA
• Nana Yaa Konadu Ampratwum
• Hope Ashlin Konapitsky

• Student in an Organized Health Care Education/Training Program in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Student in an Organized Health Care Education/Training Program in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.