Provider Demographics
NPI:1013125384
Name:SWAN-O'HANLON, LAURA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEE
Last Name:SWAN-O'HANLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1500 JOHN F KENNEDY BOULEVARD
Mailing Address - Street 2:2 PENN CENTER, SUITE 1410, C/O O'HANLON
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:267-546-9066
Mailing Address - Fax:
Practice Address - Street 1:1500 JOHN F KENNEDY BOULEVARD
Practice Address - Street 2:2 PENN CENTER, SUITE 1410, C/O O'HANLON
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:267-546-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2023-05-16
Deactivation Date:2009-01-27
Deactivation Code:
Reactivation Date:2023-05-15
Provider Licenses
StateLicense IDTaxonomies
PAMD427284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics