Provider Demographics
NPI:1801876875
Name:SWEANY, ANNA ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ELENA
Last Name:SWEANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BUTLER LANE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748
Mailing Address - Country:US
Mailing Address - Phone:732-706-5614
Mailing Address - Fax:
Practice Address - Street 1:300 WEST SYLVANIA AVE
Practice Address - Street 2:PROVIDENCE FREE MEDICAL CLINIC INC
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-5535
Practice Address - Fax:732-776-7996
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03819600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
003365Medicare ID - Type Unspecified
G61612Medicare UPIN