Healthcare Provider Details

I. General information

NPI: 1770642100
Provider Name (Legal Business Name): FRANK PETER SWANSON JR. M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COMMERCE DR
SHELTON CT
06484-6244
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-7331
  • Fax: 203-925-0330
Mailing address:
  • Phone: 203-732-1330
  • Fax: 203-732-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21155
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: