Provider Demographics
NPI:1629304548
Name:SWANN, PHILLIP C (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
Last Name:SWANN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6998 CRIDER RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2390
Mailing Address - Country:US
Mailing Address - Phone:724-778-3627
Mailing Address - Fax:724-778-3630
Practice Address - Street 1:1030 BEANER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9723
Practice Address - Country:US
Practice Address - Phone:724-775-4242
Practice Address - Fax:724-775-4960
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2011-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical