Provider Demographics
NPI:1700049905
Name:SWANSON, JAMIE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NEWTOWN RD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-5275
Mailing Address - Country:US
Mailing Address - Phone:215-675-8847
Mailing Address - Fax:215-675-6534
Practice Address - Street 1:205 NEWTOWN RD
Practice Address - Street 2:SUITE 219
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-5275
Practice Address - Country:US
Practice Address - Phone:215-675-8847
Practice Address - Fax:215-675-6534
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2184207R00000X
PAOS016705207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102882075Medicaid
PA331343Medicare PIN