Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 34006236B | OH |
NPI | 1053307389 |
---|---|
Provider Name | Dr. Mark W Byrge |
First Address | Barberton, OH 44203-3073 |
Second Address | Barberton, OH 44203-3073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 23/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2225238 | (05) | OH |
4018273 | MEDICARE ID (01) | OH |
H14493 | (02) | OH |
MA9339501 | MEDICARE ID (01) | OH |