MEDICARE: DR. AMANDA JANE SWAIN 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	207Q00000X	Family Medicine Physician	25MA07907800	NJ
2	207Q00000X	Family Medicine Physician	MD426867	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1952371833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA JANE SWAIN M.D.

Provider Business Mailing Address
First Line	:	6006 MUSKET RD
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-1810
Country	:	US
Telephone Number	:	215-805-3568
Fax Number	:	215-746-1032

Provider Business Practice Location Address
First Line	:	3535 MARKET ST
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3309
Country	:	US
Telephone Number	:	215-746-1005
Fax Number	:	215-746-1032

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/06/2008

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