Provider Demographics
NPI:1669529434
Name:DYBOWSKI, CHADWICK T (MD)
Entity type:Individual
Prefix:
First Name:CHADWICK
Middle Name:T
Last Name:DYBOWSKI
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 1:2000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3764
Mailing Address - Country:US
Mailing Address - Phone:843-416-6295
Mailing Address - Fax:
Practice Address - Street 1:2000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3764
Practice Address - Country:US
Practice Address - Phone:843-416-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074478207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4520733-10Medicaid
MIP00023039Medicare ID - Type UnspecifiedRAILROAD
MIH84908Medicare UPIN
MI4520733-10Medicaid