1306094776 NPI number — BRUCE JOHN SWEARINGEN JR. MD

Table of content: BRUCE JOHN SWEARINGEN JR. MD (NPI 1306094776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306094776 NPI number — BRUCE JOHN SWEARINGEN JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEARINGEN
Provider First Name:
BRUCE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306094776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 RESEARCH DR STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-6228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-210-6340
Provider Business Mailing Address Fax Number:
203-502-2615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWCATUCK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06379-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-315-9575
Provider Business Practice Location Address Fax Number:
401-915-9580
Provider Enumeration Date:
08/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  MD19456 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 70022 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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