Healthcare Provider Details

I. General information

NPI: 1932428885
Provider Name (Legal Business Name): PAUL VANSWEDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S LONG DR
ROCKINGHAM NC
28379-4835
US

IV. Provider business mailing address

11635 NORTHPARK DR STE 250
WAKE FOREST NC
27587-6298
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-3000
  • Fax:
Mailing address:
  • Phone: 919-825-4637
  • Fax: 919-562-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014-00622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: