Provider Demographics
NPI:1134109168
Name:BENJAMIN-SWONGER, MARY K (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:BENJAMIN-SWONGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 E VILLA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9526
Mailing Address - Country:US
Mailing Address - Phone:419-230-0991
Mailing Address - Fax:
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:419-230-0991
Practice Address - Fax:480-505-0750
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0412213E00000X, 213ES0103X
OH36002772213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0939819Medicaid
AZ1679603724Medicaid
OHH176621Medicare PIN