Provider Demographics
NPI:1144243254
Name:SWANSON, SCOTT PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PATRICK
Last Name:SWANSON
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 1:208 GRAND VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3132
Mailing Address - Country:US
Mailing Address - Phone:415-643-3355
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT EXT
Practice Address - Street 2:UNIVERSITY HEALTH SERVICES, UC BERKELEY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-642-9139
Practice Address - Fax:510-643-2997
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40516207R00000X
NVNV9160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine