Provider Demographics
NPI:1306828967
Name:SWAIM, IVETA S (MD)
Entity Type:Individual
Prefix:DR
First Name:IVETA
Middle Name:S
Last Name:SWAIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:704-384-1750
Mailing Address - Fax:704-384-1748
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-384-1750
Practice Address - Fax:704-384-1748
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913426Medicaid
SCN0106BMedicaid
NC2024349AMedicare PIN
NCH97528Medicare UPIN
NC8913426Medicaid