Provider Demographics
NPI:1306831953
Name:CHRYSSOS, ANTONIOS E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIOS
Middle Name:E
Last Name:CHRYSSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:STE 101
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1215
Mailing Address - Country:US
Mailing Address - Phone:330-966-3772
Mailing Address - Fax:330-966-3799
Practice Address - Street 1:6659 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-966-3772
Practice Address - Fax:330-966-3799
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-05-07
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
WV28147208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0742969Medicaid
OH678917OtherANTHEM BCBS
OH0742969Medicaid
OH0644664Medicare PIN
E29821Medicare UPIN