Provider Demographics
NPI:1669675880
Name:SWISHER-MCCLURE, SAMUEL D (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:SWISHER-MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:DYLAN
Other - Last Name:SWISHER-MCCLURE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-0497
Mailing Address - Country:US
Mailing Address - Phone:302-645-3775
Mailing Address - Fax:302-645-3774
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 101
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4480
Practice Address - Country:US
Practice Address - Phone:302-645-3775
Practice Address - Fax:302-645-3774
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1910122085R0001X, 390200000X
PAMD4453172085R0001X
DEC1-00242072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program