Provider Demographics
NPI:1275541690
Name:SWEENY, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:SWEENY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 7TH ST SE
Mailing Address - Street 2:SUITE G-200
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3337
Mailing Address - Country:US
Mailing Address - Phone:256-432-2033
Mailing Address - Fax:256-340-7211
Practice Address - Street 1:1215 7TH ST SE
Practice Address - Street 2:SUITE G-200
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-432-2033
Practice Address - Fax:256-340-7211
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL23078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51553856Medicaid
AL51531450OtherBCBS
AL051553856Medicare ID - Type Unspecified
AL51553856Medicaid