Provider Demographics
NPI:1265417265
Name:SWEARINGEN, PAMELA G (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:SWEARINGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8053
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:20 WALL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4758
Practice Address - Country:US
Practice Address - Phone:781-221-2500
Practice Address - Fax:781-221-2510
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6167411Medicaid
MA0015992OtherNEIGHBORHOOD HEALTH
MA3547357OtherAETNA
MA722766OtherTUFTS
MAAA8203OtherHARVARD PILGRIM
MAB10025OtherBLUE CROSS
MA12-05004OtherUNITED HEALTHCARE
MA3896460OtherCIGNA
MAE02973Medicare UPIN
MAAA8203OtherHARVARD PILGRIM