Provider Demographics
NPI:1316014285
Name:SWAIN, PRADIP (MD)
Entity Type:Individual
Prefix:
First Name:PRADIP
Middle Name:
Last Name:SWAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1810
Mailing Address - Country:US
Mailing Address - Phone:814-684-1255
Mailing Address - Fax:814-684-6393
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1810
Practice Address - Country:US
Practice Address - Phone:814-684-1255
Practice Address - Fax:814-684-6393
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-020737-E207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30954Medicare UPIN