Healthcare Provider Details

I. General information

NPI: 1770418345
Provider Name (Legal Business Name): KYLE SWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LIBERTY LN
LATROBE PA
15650-2772
US

IV. Provider business mailing address

10 LIBERTY LN
LATROBE PA
15650-2772
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-9208
  • Fax:
Mailing address:
  • Phone: 724-537-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP036237
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: