Provider Demographics
NPI:1710938592
Name:JOSEPH, SWAPNA (MD)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:JOSEPH
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 1:5103 W HAMILTON RD S
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9415
Mailing Address - Country:US
Mailing Address - Phone:260-415-9021
Mailing Address - Fax:
Practice Address - Street 1:5010 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6804
Practice Address - Country:US
Practice Address - Phone:260-369-8668
Practice Address - Fax:877-367-2115
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052976A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200333510Medicaid
INH32234Medicare UPIN
IN200333510Medicaid
IN925060YYYMedicare ID - Type Unspecified