Provider Demographics
NPI:1184698334
Name:PRYLINSKI, GREGORY VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:PRYLINSKI
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 1:3330 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2772
Mailing Address - Country:US
Mailing Address - Phone:814-866-0807
Mailing Address - Fax:814-866-3660
Practice Address - Street 1:3330 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2769
Practice Address - Country:US
Practice Address - Phone:814-866-0807
Practice Address - Fax:814-866-3660
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030597E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010837790003Medicaid
PAB37153Medicare UPIN
PA119875N9RMedicare ID - Type Unspecified