Provider Demographics
NPI:1770546707
Name:SWIFT, MARK WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:SWIFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 FOXHAVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406
Mailing Address - Country:US
Mailing Address - Phone:330-270-0056
Mailing Address - Fax:330-270-0056
Practice Address - Street 1:414 E 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3134
Practice Address - Country:US
Practice Address - Phone:330-385-8505
Practice Address - Fax:330-385-5959
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004862207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787635Medicaid
ES9747Medicare UPIN