Healthcare Provider Details

I. General information

NPI: 1548214398
Provider Name (Legal Business Name): KENNETH SZWAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

IV. Provider business mailing address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1048
  • Fax: 484-565-1048
Mailing address:
  • Phone: 484-565-1048
  • Fax: 484-565-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051561
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberA00301700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: