Provider Demographics
NPI:1306814223
Name:SWANSON, KELLY M (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:27 PARK STREET
Mailing Address - Street 2:CAPE COD HOSPITAL DAVENPORT MUGAR CANCER CENTER
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-7575
Mailing Address - Fax:508-862-7362
Practice Address - Street 1:27 PARK STREET
Practice Address - Street 2:CAPE COD HOSPITAL DAVENPORT MUGAR CANCER CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-7575
Practice Address - Fax:508-862-7362
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA225124207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28975OtherBCBS
MAAA38833OtherHPHC
I39452Medicare UPIN
A39055Medicare ID - Type Unspecified