Provider Demographics
NPI: | 1669675880 |
---|---|
Name: | SWISHER-MCCLURE, SAMUEL D (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | SAMUEL |
Middle Name: | D |
Last Name: | SWISHER-MCCLURE |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | SAMUEL |
Other - Middle Name: | DYLAN |
Other - Last Name: | SWISHER-MCCLURE |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | PO BOX 497 |
Mailing Address - Street 2: | |
Mailing Address - City: | LEWES |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19958-0497 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-645-3775 |
Mailing Address - Fax: | 302-645-3774 |
Practice Address - Street 1: | 18947 JOHN J WILLIAMS HWY UNIT 101 |
Practice Address - Street 2: | |
Practice Address - City: | REHOBOTH BEACH |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19971-4480 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-645-3775 |
Practice Address - Fax: | 302-645-3774 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-06-06 |
Last Update Date: | 2021-06-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MT191012 | 2085R0001X, 390200000X |
PA | MD445317 | 2085R0001X |
DE | C1-0024207 | 2085R0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |