Provider Demographics
NPI:1821047234
Name:SWANTEK, LEO JOSEPH JR (DO)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:JOSEPH
Last Name:SWANTEK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:SWANTEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH DO
Mailing Address - Street 1:1600 PENINSULA DR STE 9
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4261
Mailing Address - Country:US
Mailing Address - Phone:814-877-7035
Mailing Address - Fax:814-877-6276
Practice Address - Street 1:1600 PENINSULA DR STE 9
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4261
Practice Address - Country:US
Practice Address - Phone:814-877-7035
Practice Address - Fax:814-877-6276
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026403L183500000X
PAOS003267L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006115530001Medicaid
160578Medicare ID - Type Unspecified
PA0006115530001Medicaid