Basic Information
| Provider Information | |||||||||
| NPI: | 1811598154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWENSON HEALTHCARE OF MA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 PACIFIC AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984024381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008453 | ||||||||
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| Practice Location | |||||||||
| Address1: | 222 STATE ST | ||||||||
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| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010563437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533008453 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAHDUL | ||||||||
| AuthorizedOfficialFirstName: | ADNAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 2533008453 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | S100693934 | 05 | MA | MEDICAID |