Provider Demographics
NPI:1194832774
Name:SWANSON, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 WASON AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1119
Mailing Address - Country:US
Mailing Address - Phone:413-241-2100
Mailing Address - Fax:413-735-1986
Practice Address - Street 1:100 WASON AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1119
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:413-735-1986
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA203565208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3206441Medicaid
MAJ22150OtherBCBS
MA3206441Medicaid