Basic Information
| Provider Information | |||||||||
| NPI: | 1487946042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | RANDEL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | DO, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 LOMBARD ST FL 1 | ||||||||
| Address2: | PENN MEDICINE RITTENHOUSE, DEPT OF PHYSICAL MED & REHAB | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158932600 | ||||||||
| FaxNumber: | 2158932686 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 LOMBARD ST FL 1 | ||||||||
| Address2: | PENN MEDICINE RITTENHOUSE, DEPT OF PHYSICAL MED & REHAB | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158932600 | ||||||||
| FaxNumber: | 2158932686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2011 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | OS017055 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 25MB09357000 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.