Provider Demographics
NPI:1447359963
Name:SWEINHART, MARTY DAWN (MD)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:DAWN
Last Name:SWEINHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 W BLACKWELL ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2560
Mailing Address - Country:US
Mailing Address - Phone:973-620-9000
Mailing Address - Fax:973-891-1457
Practice Address - Street 1:369 W BLACKWELL ST
Practice Address - Street 2:UNIT 1
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:973-620-9000
Practice Address - Fax:973-891-1457
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06119200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5655102Medicaid
NJ5655102Medicaid
G35612Medicare UPIN