Healthcare Provider Details

I. General information

NPI: 1831168384
Provider Name (Legal Business Name): JON HALLIE SWENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JON SWENSON MD

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 THIMBLE SHOALS BLVD STE 130
NEWPORT NEWS VA
23606-4562
US

IV. Provider business mailing address

730 THIMBLE SHOALS BLVD STE 130
NEWPORT NEWS VA
23606-4562
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-1554
  • Fax: 757-873-3239
Mailing address:
  • Phone: 757-873-1554
  • Fax: 757-873-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101046095
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0101046095
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101046095
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101046095
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: