Basic Information
| Provider Information | |||||||||
| NPI: | 1609819788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANGER | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853683720 | ||||||||
| FaxNumber: | 5853683723 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 S CLINTON AVE | ||||||||
| Address2: | BUILDING H SUITE 110 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852713800 | ||||||||
| FaxNumber: | 5854614426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 187595 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01400595 | 05 | NY | MEDICAID |