MEDICARE: VIRGINIA E SWANSON MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD00040778	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	163901	OTHER	WA	DEPARTMENT OF L&I
3	610902800	OTHER	WA	OWCP

General Provider Information

NPI Number	:	1629138631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA E SWANSON MD PLLC

Provider Business Mailing Address
First Line	:	17791 FJORD DR NE
Second Line	:	SUITE 110
City	:	POULSBO
State	:	WA
Zip	:	98370-8481
Country	:	US
Telephone Number	:	360-626-9034
Fax Number	:	360-626-9046

Provider Business Practice Location Address
First Line	:	17791 FJORD DR NE
Second Line	:	SUITE 110
City	:	POULSBO
State	:	WA
Zip	:	98370-8481
Country	:	US
Telephone Number	:	360-626-9034
Fax Number	:	360-626-9046

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VIRGINIA E SWANSON
Credential	:	MD
Telephone Number	:	360-626-9034

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/23/2011

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