Provider Demographics
NPI:1902996481
Name:SWENSON, EUGENE SCOTT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:SCOTT
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CEDAR ST.
Mailing Address - Street 2:LMP1080
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8019
Mailing Address - Country:US
Mailing Address - Phone:203-785-4138
Mailing Address - Fax:203-785-7273
Practice Address - Street 1:330 CEDAR ST
Practice Address - Street 2:LMP1080
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8019
Practice Address - Country:US
Practice Address - Phone:203-785-4138
Practice Address - Fax:203-785-7273
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040636207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010040636CT02OtherANTHEM BCBS