Healthcare Provider Details

I. General information

NPI: 1891537460
Provider Name (Legal Business Name): MICHAEL RICHARD SWAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WATER ST STE 203
LACONIA NH
03246-3300
US

IV. Provider business mailing address

PO BOX 177
GILMANTON NH
03237-0177
US

V. Phone/Fax

Practice location:
  • Phone: 603-259-1977
  • Fax:
Mailing address:
  • Phone: 603-259-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2044
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: