Basic Information
| Provider Information | |||||||||
| NPI: | 1508092388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRZYBYSZ | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80690 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447080690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303637444 | ||||||||
| FaxNumber: | 3303637770 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 SIXTH ST SW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447101702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304529911 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2009 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2014-01828 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | 2014-01828 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | 35.144641 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1508092388 | 05 | NC | MEDICAID | NC2231 | 05 | SC | MEDICAID |