Provider Demographics
NPI:1417088428
Name:SWISHER, DAVID E
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:SWISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5357 ACORN DR
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:PA
Mailing Address - Zip Code:16647-8353
Mailing Address - Country:US
Mailing Address - Phone:814-658-3380
Mailing Address - Fax:
Practice Address - Street 1:373 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1270
Practice Address - Country:US
Practice Address - Phone:814-644-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 007785-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001614095Medicaid