Provider Demographics
NPI:1053307389
Name:BYRGE, MARK W (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:BYRGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 5TH ST NE
Mailing Address - Street 2:STE. 8
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3073
Mailing Address - Country:US
Mailing Address - Phone:330-475-1616
Mailing Address - Fax:330-475-1617
Practice Address - Street 1:210 5TH ST NE
Practice Address - Street 2:STE. 8
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3073
Practice Address - Country:US
Practice Address - Phone:330-475-1616
Practice Address - Fax:330-475-1617
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006236B2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2225238Medicaid
OHMA9339501OtherMEDICARE ID
OH4018273OtherMEDICARE ID
OHH14493Medicare UPIN