Basic Information
| Provider Information | |||||||||
| NPI: | 1346337987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 826 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194604459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104151100 | ||||||||
| FaxNumber: | 6104151101 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194604459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104151100 | ||||||||
| FaxNumber: | 6104151101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD071542L | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 220324YEXC | 01 | PA | MEDICARE PTAN | OTHER |