Provider Demographics
NPI:1194862581
Name:SWABB, SCOTT W (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:SWABB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 N COUNTY ROAD 25A STE 106
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1373
Mailing Address - Country:US
Mailing Address - Phone:937-778-1000
Mailing Address - Fax:937-440-4275
Practice Address - Street 1:3006 N COUNTY ROAD 25A STE 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-778-1000
Practice Address - Fax:937-440-4275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0988794Medicaid
OH4232311Medicare PIN
OH0988794Medicaid