Healthcare Provider Details

I. General information

NPI: 1144285461
Provider Name (Legal Business Name): CHANNING S SWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RIVERWAY PL
BEDFORD NH
03110-6768
US

IV. Provider business mailing address

703 RIVERWAY PL
BEDFORD NH
03110-6768
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-7096
  • Fax: 603-669-6944
Mailing address:
  • Phone: 603-668-7096
  • Fax: 603-669-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number6467
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: