Provider Demographics
NPI:1215965470
Name:CWYNAR, ERIC JOHN (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:CWYNAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:J
Other - Last Name:CWYNAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:117 LAZELLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8605
Mailing Address - Country:US
Mailing Address - Phone:614-885-3338
Mailing Address - Fax:614-476-6944
Practice Address - Street 1:117 LAZELLE RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-8605
Practice Address - Country:US
Practice Address - Phone:614-885-3338
Practice Address - Fax:614-476-6944
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003022213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080537Medicaid
OH1062950006Medicare NSC
OH1062950002Medicare NSC
OHCW4064734Medicare PIN
U67612Medicare UPIN
OH1062950005Medicare NSC
OHCW4064739Medicare PIN
OHCW4064737Medicare PIN
OHCW4064738Medicare PIN
OHCW4064736Medicare PIN
OH1062950013Medicare NSC