Provider Demographics
NPI:1528386588
Name:SWIFT, CHARLENE BLAKE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:BLAKE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:MARIE
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:500 PARNASSUS AVE
Mailing Address - Street 2:WEST TOWER, 4TH FLOOR, BOX 0122
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2203
Mailing Address - Country:US
Mailing Address - Phone:415-514-1119
Mailing Address - Fax:
Practice Address - Street 1:500 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-514-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027909207L00000X
CAA136169207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology