Healthcare Provider Details

I. General information

NPI: 1780802173
Provider Name (Legal Business Name): MR. PAUL R. SWARTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 JAMESCREST DR
BECKLEY WV
25801-2184
US

IV. Provider business mailing address

504 JAMESCREST DR
BECKLEY WV
25801-2184
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-2016
  • Fax:
Mailing address:
  • Phone: 304-253-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number800471
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number800471
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number800471
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number800471
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: