Provider Demographics
NPI:1134103666
Name:SWEET, CONSTANCE M (MD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:SWEET
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 1:71 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:570-265-6300
Mailing Address - Fax:570-268-2807
Practice Address - Street 1:1425 GOLDEN MILE ROAD
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-265-9158
Practice Address - Fax:570-265-1687
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061835L207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016604090005Medicaid
PA706874EQVMedicare PIN
PA706874UT3Medicare PIN
PA0016604090005Medicaid