Basic Information
| Provider Information | |||||||||
| NPI: | 1902996481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWENSON | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 CEDAR ST. | ||||||||
| Address2: | LMP1080 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854138 | ||||||||
| FaxNumber: | 2037857273 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 CEDAR ST | ||||||||
| Address2: | LMP1080 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037854138 | ||||||||
| FaxNumber: | 2037857273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 11/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 040636 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 010040636CT02 | 01 | CT | ANTHEM BCBS | OTHER |