Healthcare Provider Details

I. General information

NPI: 1275796120
Provider Name (Legal Business Name): IRENE QUIAMBAO PERMUT SWIFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE QUIAMBAO PERMUT

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN-STANTON ROAD MAP 1, SUITE 220
NEWARK DE
19713-2074
US

IV. Provider business mailing address

200 HYGEIA DRIVE CCHS PHYSICIAN CONTRACTING, SUITE 2300
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-368-5515
  • Fax: 302-325-7056
Mailing address:
  • Phone: 856-429-1800
  • Fax: 856-429-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA09531200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA09531200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA09531200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC1-0011513
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: