Provider Demographics
NPI:1417081043
Name:PETER A SWABY DO LLC
Entity Type:Organization
Organization Name:PETER A SWABY DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:INYANGSWABY
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH ADMIN
Authorized Official - Phone:301-809-6206
Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 422
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-809-6206
Mailing Address - Fax:301-809-6225
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 422
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-809-6206
Practice Address - Fax:301-809-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698302200Medicaid
MDG66608Medicare UPIN