Healthcare Provider Details

I. General information

NPI: 1043374218
Provider Name (Legal Business Name): RYAN C KOBYLINSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W 25TH ST # 3R
ERIE PA
16544-7976
US

IV. Provider business mailing address

2445 W 34TH ST
ERIE PA
16506-3599
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-5530
  • Fax: 814-452-5419
Mailing address:
  • Phone: 814-835-7621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS014706
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: