Provider Demographics
NPI:1710228838
Name:MCSWAIN MEDICAL OF AUBURN PLLC
Entity Type:Organization
Organization Name:MCSWAIN MEDICAL OF AUBURN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-730-7448
Mailing Address - Street 1:121 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1113
Mailing Address - Country:US
Mailing Address - Phone:315-391-1281
Mailing Address - Fax:
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-252-0000
Practice Address - Fax:315-252-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201382-1261QU0200X
NY006151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02208226Medicaid
NYG77223Medicare UPIN