Healthcare Provider Details

I. General information

NPI: 1104864495
Provider Name (Legal Business Name): DAVID J PRYBYLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RESEARCH PL
NORTH CHELMSFORD MA
01863-2412
US

IV. Provider business mailing address

14 RESEARCH PL
NORTH CHELMSFORD MA
01863-2412
US

V. Phone/Fax

Practice location:
  • Phone: 978-454-0706
  • Fax: 978-970-0454
Mailing address:
  • Phone: 978-454-0706
  • Fax: 978-970-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number216552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: