Provider Demographics
NPI:1457300063
Name:SWAYZE, COLLEEN F (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:F
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD
Mailing Address - Street 2:STE 375
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5378
Mailing Address - Country:US
Mailing Address - Phone:513-221-3800
Mailing Address - Fax:513-682-4520
Practice Address - Street 1:3050 MACK RD
Practice Address - Street 2:STE 375
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5378
Practice Address - Country:US
Practice Address - Phone:513-221-3800
Practice Address - Fax:513-682-4528
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2117435Medicaid
G95961Medicare UPIN
OHSW0879493Medicare ID - Type Unspecified