MEDICARE: DR. SALLY H SWISHER MD

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	2084N0400X	Neurology Physician	12350	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00352206	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	001706315	OTHER	WV	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821029232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY H SWISHER MD

Provider Business Mailing Address
First Line	:	401 DIVISION ST
Second Line	:	SUITE 302
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-767-7940
Fax Number	:	304-767-7945

Provider Business Practice Location Address
First Line	:	401 DIVISION ST
Second Line	:	SUITE 302
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-767-7940
Fax Number	:	304-767-7945

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/21/2008

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Directions to “ DR. SALLY H SWISHER MD” Practice Location

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