Provider Demographics
NPI:1285717405
Name:SWEARINGEN, PHILLIP VAN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:VAN
Last Name:SWEARINGEN
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 1:200 WEDGEWOOD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2442
Mailing Address - Country:US
Mailing Address - Phone:304-599-1448
Mailing Address - Fax:304-599-5335
Practice Address - Street 1:200 WEDGEWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2442
Practice Address - Country:US
Practice Address - Phone:304-599-1448
Practice Address - Fax:304-599-5335
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13839207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV13839OtherHEALTHPLAN UPPER OHIO VAL
100007159OtherRAILROAD MEDICARE
134309OtherUNISON
000122409OtherBLUE CROSS BLUE SHIELD
WV0088634000Medicaid
7019141Medicare ID - Type Unspecified
134309OtherUNISON