Provider Demographics
NPI:1881625226
Name:SZEWCZYK, GREGORY P (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:SZEWCZYK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1031 W WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3541
Practice Address - Country:US
Practice Address - Phone:330-965-0900
Practice Address - Fax:330-965-9250
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN311353L367500000X
OHRN230867367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081046OtherMEDICARE PTAN
OHH163530OtherMEDICARE PTAN
OH2483183Medicaid