Provider Demographics
NPI:1235121179
Name:SWAN, CHAD R (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:SWAN
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 1:353 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:SUITE B224
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2379
Mailing Address - Country:US
Mailing Address - Phone:615-206-1700
Mailing Address - Fax:615-590-7268
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE B224
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-206-1700
Practice Address - Fax:615-590-7268
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40052208600000X, 2086S0129X
TNMD0000040052208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10071053OtherAMERIGROUP COMMUNITY CARE
TN4108377OtherBCBS
TNTN0103OtherAMERICHOICE
TN3333844Medicaid
TN4235262OtherBCBS OF TN
TN7654686OtherAETNA
TN1514851Medicaid
TNP00294160OtherRAILROAD MEDICARE
KY64130941OtherKY MEDICAID
TN3333844Medicaid
TN4235262OtherBCBS OF TN
I40619Medicare UPIN
TNI40619Medicare UPIN