Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34-010094 | OH |
N | 207P00000X | Emergency Physician | OT011707 | PA |
NPI | 1013175835 |
---|---|
Provider Name | Dr. Kevin A Andryc |
First Address | Chardon, OH 44024-9161 |
Second Address | Erie, PA 16550-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 13/04/2021 |