Provider Demographics
NPI:1689690067
Name:SCHWANZ, JOAN I (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:I
Last Name:SCHWANZ
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:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-801-7900
Mailing Address - Fax:704-892-3889
Practice Address - Street 1:705 GRIFFITH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9304
Practice Address - Country:US
Practice Address - Phone:704-801-7900
Practice Address - Fax:704-892-3889
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00746Medicaid
NC891094RMedicaid
NC1689690067Medicaid
SCN00746Medicaid
NCNCL347AMedicare PIN
NC2247915DMedicare PIN
NC2247915EMedicare PIN
NC1689690067Medicaid
NC891094RMedicaid
NC2247915CMedicare PIN