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General NPI Number Information
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NPI Number | 1053307389
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Entity Type | Individual
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Provider Name | MARK W BYRGE D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 210 5TH ST NE STE. 8
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City | BARBERTON
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State | OH
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Zip | 44203-3073
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Country | US
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Telephone | 330-475-1616
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Fax | 330-475-1617
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Provider Business Mailing Address
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Address Line | 210 5TH ST NE STE. 8
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City | BARBERTON
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State | OH
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Zip | 44203-3073
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Country | US
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Telephone | 330-475-1616
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Fax | 330-475-1617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 34006236B
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License Number State | OH
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