Healthcare Provider Details

I. General information

NPI: 1750537163
Provider Name (Legal Business Name): DENNIS D SWAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N MAIN ST
BLACKSTONE VA
23824-1425
US

IV. Provider business mailing address

213 N MAIN ST
BLACKSTONE VA
23824-1425
US

V. Phone/Fax

Practice location:
  • Phone: 434-292-7261
  • Fax: 434-298-0908
Mailing address:
  • Phone: 434-292-7261
  • Fax: 434-298-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101-244145
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: