Provider Demographics
NPI:1467565242
Name:SWAN, JACQUELINE ANN (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:SWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 136P
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:877-379-5522
Mailing Address - Fax:978-948-5200
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 136P
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:877-379-5522
Practice Address - Fax:978-948-5200
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA217332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084256AMedicaid
MA110084256AMedicaid
MA001412501Medicare PIN