Provider Demographics
NPI:1538136759
Name:SWANSON, GEORGE ALDEN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALDEN
Last Name:SWANSON
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:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-8816
Mailing Address - Fax:
Practice Address - Street 1:990 OAK RIDGE TPKE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6976
Practice Address - Country:US
Practice Address - Phone:865-481-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29323207P00000X, 207LC0200X
WV22843207L00000X, 207L00000X
HIMD-17172207LC0200X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HII08123Medicare UPIN
WV20554238700OtherBRICKSTREET GROUP
WV0207026000Medicaid
WV205542387OtherTRICARE
WV3810009026Medicaid
WVP00453015OtherRR MEDICARE
WV001706469OtherMSBCBS GROUP
OH2460484Medicaid
OH2783877Medicaid
WV9333201Medicare PIN
WVP00425216OtherRR MEDICARE
WVDF0767OtherRR MEDICARE
WV9364011Medicare PIN
WV1071630OtherBRICK STREET
WV001964246OtherMSBCBS
WV4211031Medicare PIN
WVDA0096OtherRR MEDICARE
WV270052997004OtherTRICARE
IO8123Medicare UPIN
WV4211032Medicare PIN