MEDICARE: RANDY L SWACKHAMMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	33315	NC
2	208D00000X	General Practice Physician	33315	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01133879	OTHER	NC	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770607228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY L SWACKHAMMER M.D.

Provider Business Mailing Address
First Line	:	2400 WAYNE MEMORIAL DR STE C
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1750
Country	:	US
Telephone Number	:	919-988-9674
Fax Number	:	919-988-9676

Provider Business Practice Location Address
First Line	:	2400 WAYNE MEMORIAL DR STE C
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1750
Country	:	US
Telephone Number	:	919-988-9674
Fax Number	:	919-988-9676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	01/18/2017

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Directions to “ RANDY L SWACKHAMMER M.D.” Practice Location

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