Provider Demographics
NPI:1558365528
Name:SWISHER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:SWISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:SB-5
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4530
Mailing Address - Fax:859-258-4870
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:SB-5
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4530
Practice Address - Fax:859-258-4870
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0037676OtherMEDICARE - FAYETTE COUNTY HEALTH DEPARTMENT
KY611012421POtherHUMANA HMO
KY000000047818OtherANTHEM BC/BS
KY0400544OtherUNITED HEALTHCARE
KY1404232OtherUMWA
KY0400360OtherUNITED HEALTHCARE
KY110136243OtherRAILROAD MEDICARE
KY1284109OtherUMWA
KY64-244361Medicaid
KY0400544OtherUNITED HEALTHCARE
KY1284109OtherUMWA
KY1404232OtherUMWA
KY64-244361Medicaid