Provider Demographics
NPI:1750537163
Name:SWAN, DENNIS D (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
Last Name:SWAN
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 1:213 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1425
Mailing Address - Country:US
Mailing Address - Phone:434-292-7261
Mailing Address - Fax:434-298-0908
Practice Address - Street 1:213 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1425
Practice Address - Country:US
Practice Address - Phone:434-292-7261
Practice Address - Fax:434-298-0908
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-244145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VAP00721645OtherMEDICARE RAILROAD