Provider Demographics
NPI:1063464311
Name:SCHWAB, JENNIFER LINDWALL (MD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDWALL
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LINDWALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:546 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-721-7561
Mailing Address - Fax:860-721-9199
Practice Address - Street 1:546 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-721-7561
Practice Address - Fax:860-721-9199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039307208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2523614OtherOXFORD
2V1038OtherHEALTHNET
01245ROtherBCBS UPIN
2170152OtherUNITED
CT0393070688OtherCONNECTICARE
CT06158556801Medicaid
010039307CT01OtherBCBS