Healthcare Provider Details

I. General information

NPI: 1073730248
Provider Name (Legal Business Name): CHRISTOPHER GREGORY PRZYBYCIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE L25
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE L25
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-8421
  • Fax: 216-445-3707
Mailing address:
  • Phone: 216-444-8421
  • Fax: 216-445-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301081662
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number35.098560
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number43060
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301081682
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD67176
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number252621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: