Provider Demographics
NPI:1093741217
Name:SWAN, MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4464
Mailing Address - Fax:207-564-4461
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4464
Practice Address - Fax:207-564-4461
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP154001OtherPTAN
P01258440OtherRR MEDICARE