Provider Demographics
NPI:1609866532
Name:SWAN, JANE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LOUISE
Last Name:SWAN
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 1:7605 KELMSCOT WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5712
Mailing Address - Country:US
Mailing Address - Phone:919-819-6905
Mailing Address - Fax:
Practice Address - Street 1:7605 KELMSCOT WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5712
Practice Address - Country:US
Practice Address - Phone:919-819-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC210529KMedicare PIN