Provider Demographics
NPI:1669506804
Name:SWANSEA PEDIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:SWANSEA PEDIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-379-9605
Mailing Address - Street 1:2200 G A R HWY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3935
Mailing Address - Country:US
Mailing Address - Phone:508-379-9605
Mailing Address - Fax:508-379-9813
Practice Address - Street 1:2200 G A R HWY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3935
Practice Address - Country:US
Practice Address - Phone:508-379-9605
Practice Address - Fax:508-379-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty