Provider Demographics
NPI:1407947302
Name:SWAMY, CHANDRA S (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:S
Last Name:SWAMY
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 1:30 MEDICAL PARK
Mailing Address - Street 2:SUITE 232
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-9560
Mailing Address - Fax:304-242-4840
Practice Address - Street 1:30 MEDICAL PARK
Practice Address - Street 2:SUITE 232
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-9560
Practice Address - Fax:304-242-4840
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH046 3083Medicaid
WV0094468000Medicaid
0521353Medicare ID - Type Unspecified
WV0094468000Medicaid