Provider Demographics
NPI:1396044889
Name:SWICK, DEVON MARIE (DO)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:MARIE
Last Name:SWICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9226
Mailing Address - Country:US
Mailing Address - Phone:614-508-6555
Mailing Address - Fax:
Practice Address - Street 1:153 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9226
Practice Address - Country:US
Practice Address - Phone:614-508-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-010773208000000X
OH34010773208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100190Medicaid