Provider Demographics
NPI:1043385370
Name:KORNYLAK, HAROLD (DO)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:KORNYLAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 E BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3760
Mailing Address - Country:US
Mailing Address - Phone:757-491-3294
Mailing Address - Fax:480-275-3481
Practice Address - Street 1:1432 E BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3760
Practice Address - Country:US
Practice Address - Phone:757-491-3294
Practice Address - Fax:480-275-3481
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036958204D00000X
HIDOS1022204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA26561Medicare UPIN