MEDICARE: DAVID SWAN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1881718377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SWAN

Provider Business Mailing Address
First Line	:	2227 OLD EMMORTON ROAD
Second Line	:	SUITE 119
City	:	BEL AIR
State	:	MD
Zip	:	21015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 FREDERICK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-3218
Country	:	US
Telephone Number	:	410-893-4600
Fax Number	:	410-569-0094

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ DAVID SWAN ” Practice Location

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