Provider Demographics
NPI:1306223060
Name:SWARTZWELDER-COZAD, ELIZABETH RAE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RAE
Last Name:SWARTZWELDER-COZAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:RAE
Other - Last Name:SWARTZWELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 FALLS CREEK DR
Mailing Address - Street 2:# B
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-8600
Mailing Address - Country:US
Mailing Address - Phone:937-734-4141
Mailing Address - Fax:937-277-7249
Practice Address - Street 1:2261 PHILADELPHIA DRIVE
Practice Address - Street 2:FIVE RIVERS FAMILY HEALTH CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-734-4141
Practice Address - Fax:937-277-7249
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine