Provider Demographics
NPI:1265585392
Name:MARK E SWETZ MD,PC
Entity type:Organization
Organization Name:MARK E SWETZ MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-674-1414
Mailing Address - Street 1:3065 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1239
Mailing Address - Country:US
Mailing Address - Phone:716-674-1414
Mailing Address - Fax:716-674-1473
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:716-674-1414
Practice Address - Fax:716-674-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0380Medicare ID - Type Unspecified
NYG06611Medicare UPIN