Provider Demographics
NPI:1518018308
Name:SWANSON, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4222 NEW LEAF LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-7918
Mailing Address - Country:US
Mailing Address - Phone:919-941-1911
Mailing Address - Fax:919-941-1901
Practice Address - Street 1:5400 S. MIAMI BLVD.
Practice Address - Street 2:SUITE 112
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8465
Practice Address - Country:US
Practice Address - Phone:919-941-1911
Practice Address - Fax:919-941-1901
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC034174207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE65573Medicare UPIN