Healthcare Provider Details

I. General information

NPI: 1457575615
Provider Name (Legal Business Name): SWAPNIL VAIDYA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9433 N BEACH ST STE 111
FORT WORTH TX
76244
US

IV. Provider business mailing address

9433 N BEACH ST STE 111
FORT WORTH TX
76244-6306
US

V. Phone/Fax

Practice location:
  • Phone: 817-428-7000
  • Fax:
Mailing address:
  • Phone: 817-428-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberP0805
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberP0805
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberP0805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: