Provider Demographics
NPI:1760879878
Name:CHARLES A SWANSON
Entity Type:Organization
Organization Name:CHARLES A SWANSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF DERMATOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-462-4401
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-4401
Mailing Address - Fax:978-462-0145
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-4401
Practice Address - Fax:978-462-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41349302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110000930AMedicaid
MA110000930AMedicaid