Provider Demographics
NPI:1821029232
Name:SWISHER, SALLY H (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:H
Last Name:SWISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DIVISION ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1455
Mailing Address - Country:US
Mailing Address - Phone:304-767-7940
Mailing Address - Fax:304-767-7945
Practice Address - Street 1:401 DIVISION ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-767-7940
Practice Address - Fax:304-767-7945
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV123502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00352206OtherRAILROAD MEDICARE
WV001706315OtherBLUE CROSS
WV0090987000Medicaid
WVP00352206OtherRAILROAD MEDICARE
WV0478174Medicare ID - Type UnspecifiedMEDICARE