Provider Demographics
NPI:1467490854
Name:SWARUP, JITENDRA (MD)
Entity Type:Individual
Prefix:
First Name:JITENDRA
Middle Name:
Last Name:SWARUP
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 1:1503 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3243
Mailing Address - Country:US
Mailing Address - Phone:252-335-5446
Mailing Address - Fax:252-335-4153
Practice Address - Street 1:1503 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3243
Practice Address - Country:US
Practice Address - Phone:252-335-5446
Practice Address - Fax:252-335-4153
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501120207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1263730002OtherDMERC
NC8981164Medicaid
NC1263730004OtherDMERC
NC1263730004OtherDMERC
G06677Medicare UPIN