Basic Information
| Provider Information | |||||||||
| NPI: | 1053307389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYRGE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 5TH ST NE | ||||||||
| Address2: | STE. 8 | ||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442033073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304751616 | ||||||||
| FaxNumber: | 3304751617 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 5TH ST NE | ||||||||
| Address2: | STE. 8 | ||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442033073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304751616 | ||||||||
| FaxNumber: | 3304751617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 11/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 34006236B | OH | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2225238 | 05 | OH | MEDICAID | MA9339501 | 01 | OH | MEDICARE ID | OTHER | 4018273 | 01 | OH | MEDICARE ID | OTHER |