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General NPI Number Information
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NPI Number | 1447372552
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Entity Type | Individual
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Provider Name | ANTHONY WYNSHAW-BORIS M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 10900 EUCLID AVE BRB731
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City | CLEVELAND
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State | OH
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Zip | 44106-1712
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Country | US
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Telephone | 216-368-0581
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Fax | 216-368-3832
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Provider Business Mailing Address
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Address Line | 10900 EUCLID AVE BRB731
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City | CLEVELAND
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State | OH
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Zip | 44106-1712
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Country | US
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Telephone | 216-368-0581
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Fax | 216-368-3832
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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 | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | C50634
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License Number State | OH
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