Provider Demographics
NPI:1063465953
Name:SWAD, SAMUEL J (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:SWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:5815 BLAKENEY PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5731
Practice Address - Country:US
Practice Address - Phone:704-316-5080
Practice Address - Fax:704-316-5085
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4210Medicaid
SCN194346Medicaid
NC5914074Medicaid
SC20-2660098OtherGAFFNEY MEDICAL ASSOCIATE
SC202660098OtherGAFFNEY HMA PHYSICIAN MANAGEMENT
SCG39775Medicare UPIN
SCGP4210Medicaid
SC202660098OtherGAFFNEY HMA PHYSICIAN MANAGEMENT
NC5914074Medicaid