Provider Demographics
NPI:1225666753
Name:SWING, IRINA V (PA)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:SWING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-6810
Mailing Address - Country:US
Mailing Address - Phone:703-282-1492
Mailing Address - Fax:
Practice Address - Street 1:131 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2452
Practice Address - Country:US
Practice Address - Phone:703-282-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program