Provider Demographics
NPI:1053347294
Name:SWANN, WILLIAM BURNICE JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BURNICE
Last Name:SWANN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 MERCHANT ST APT D213
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3541
Mailing Address - Country:US
Mailing Address - Phone:240-409-3486
Mailing Address - Fax:240-559-0949
Practice Address - Street 1:121-123 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727
Practice Address - Country:US
Practice Address - Phone:240-409-3486
Practice Address - Fax:240-559-0949
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0037188207P00000X
MDH37188208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621871700Medicaid
D32857Medicare UPIN
MD00A139B82Medicare ID - Type Unspecified