Provider Demographics
NPI:1447372552
Name:WYNSHAW-BORIS, ANTHONY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:WYNSHAW-BORIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 EUCLID AVE
Mailing Address - Street 2:BRB731
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1712
Mailing Address - Country:US
Mailing Address - Phone:216-368-0581
Mailing Address - Fax:216-368-3832
Practice Address - Street 1:10900 EUCLID AVE
Practice Address - Street 2:BRB731
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1712
Practice Address - Country:US
Practice Address - Phone:216-368-0581
Practice Address - Fax:216-368-3832
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC50634207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics