Basic Information
| Provider Information | |||||||||
| NPI: | 1477625374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KWAN | ||||||||
| FirstName: | EDDIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 E NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123592459 | ||||||||
| FaxNumber: | 4123598233 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 E NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152124756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123592459 | ||||||||
| FaxNumber: | 4123598233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | 015102 | ME | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | MD440827 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 037599 | 01 | ME | ANTHEM | OTHER | M98346 | 01 | ME | CIGNA | OTHER | 0007466048 | 01 | ME | AETNA | OTHER | 328510099 | 05 | ME | MEDICAID | 2323475 | 01 | ME | AETNA USHC | OTHER | 30004207 | 05 | NH | MEDICAID | 01Y004120NH01 | 01 | NH | ANTHEM | OTHER | MN3415 | 01 | ME | HPHC | OTHER |