Healthcare Provider Details

I. General information

NPI: 1831475730
Provider Name (Legal Business Name): ANDREA JENNIFER CHAMCZUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 07/15/2025
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1928
  • Fax: 330-744-2110
Mailing address:
  • Phone: 330-743-1928
  • Fax: 330-744-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number82475
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number28190
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.141789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: