MEDICARE: DR. SWAPNA VEERABHADRIAH CHENNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A114475	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	2012-00540	NC

General Provider Information

NPI Number	:	1164688644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SWAPNA VEERABHADRIAH CHENNA M.D.

Provider Business Mailing Address
First Line	:	6102 GRACE PARK DR
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6003
Country	:	US
Telephone Number	:	919-235-6405
Fax Number	:	919-235-6406

Provider Business Practice Location Address
First Line	:	6102 GRACE PARK DR
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-6003
Country	:	US
Telephone Number	:	919-235-6405
Fax Number	:	919-235-6406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	01/09/2013

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