Provider Demographics
NPI:1508972266
Name:SWABY, PETER ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:SWABY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 MITCHELLVILLE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1383
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 B422
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052843207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD698302200Medicaid
MD698302200Medicaid
MDG00577Medicare ID - Type Unspecified