Provider Demographics
NPI:1164688644
Name:CHENNA, SWAPNA VEERABHADRIAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SWAPNA
Middle Name:VEERABHADRIAH
Last Name:CHENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 GRACE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6003
Mailing Address - Country:US
Mailing Address - Phone:919-235-6405
Mailing Address - Fax:919-235-6406
Practice Address - Street 1:6102 GRACE PARK DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6003
Practice Address - Country:US
Practice Address - Phone:919-235-6405
Practice Address - Fax:919-235-6406
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114475207Q00000X
390200000X
NC2012-00540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program