Provider Demographics
NPI:1174524664
Name:SWANSON, MAURICE G (MD)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:G
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OVERBROOK DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-3101
Mailing Address - Country:US
Mailing Address - Phone:513-539-7356
Mailing Address - Fax:513-539-7782
Practice Address - Street 1:20 OVERBROOK DR
Practice Address - Street 2:UNIT C
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-3101
Practice Address - Country:US
Practice Address - Phone:513-539-7356
Practice Address - Fax:513-539-7782
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH61100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0835869Medicaid
OHG73153Medicare UPIN
OH0835869Medicaid
OHSW0692831Medicare PIN