Provider Demographics
NPI:1770501405
Name:SWIDLER, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SWIDLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:PO BOX 208028
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-6977
Mailing Address - Fax:203-785-3712
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:NORTH PAVILION 4-202
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-200-2725
Practice Address - Fax:203-200-2099
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-05-19
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Provider Licenses
StateLicense IDTaxonomies
CT35788207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02532781Medicaid
A57931Medicare UPIN
NY02532781Medicaid