MEDICARE: MARY E SWAYKUS M.D.

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	207Q00000X	Family Medicine Physician	029858	CT

General Provider Information

NPI Number	:	1710083134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E SWAYKUS M.D.

Provider Business Mailing Address
First Line	:	842 WASHINGTON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2912
Country	:	US
Telephone Number	:	860-346-4484
Fax Number	:	860-347-1343

Provider Business Practice Location Address
First Line	:	842 WASHINGTON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2912
Country	:	US
Telephone Number	:	860-346-4484
Fax Number	:	860-347-1343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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