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General NPI Number Information
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NPI Number | 1497916126
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Entity Type | Individual
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Provider Name | REBECCA SWAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 4900 BROAD RD
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-492-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BOSTON MEDICAL CTR PL
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City | BOSTON
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State | MA
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Zip | 02118-2908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 278921
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License Number State | NY
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