1144285461 NPI number — DR. CHANNING S SWAN MD

Table of content: DR. CHANNING S SWAN MD (NPI 1144285461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144285461 NPI number — DR. CHANNING S SWAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAN
Provider First Name:
CHANNING
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144285461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 RIVERWAY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-6768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-7096
Provider Business Mailing Address Fax Number:
603-669-6944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 RIVERWAY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-668-7096
Provider Business Practice Location Address Fax Number:
603-669-6944
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  6467 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0105456Y0NH03 . This is a "BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2785 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2201427 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 81303451 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006467 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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