Healthcare Provider Details

I. General information

NPI: 1629304548
Provider Name (Legal Business Name): PHILLIP C. SWANN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BEANER HOLLOW RD
BEAVER PA
15009-9723
US

IV. Provider business mailing address

6998 CRIDER RD
MARS PA
16046-2390
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-4242
  • Fax: 724-775-4960
Mailing address:
  • Phone: 724-778-3627
  • Fax: 724-778-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054072
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: