Provider Demographics
NPI:1750319935
Name:SWEAZY, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:SWEAZY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3405
Mailing Address - Country:US
Mailing Address - Phone:803-796-8515
Mailing Address - Fax:803-796-8516
Practice Address - Street 1:111 WEST HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3405
Practice Address - Country:US
Practice Address - Phone:803-796-8515
Practice Address - Fax:803-796-8516
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18292174400000X
SC21-8292208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT22071Medicaid
SCT22071Medicaid
SCF65350Medicare UPIN
SCT22071Medicaid