Provider Demographics
NPI:1154367480
Name:SCHWARTZ, ELLEN CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CHRISTINE
Last Name:SCHWARTZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-341-3114
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1400 NORTH GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-578-5241
Practice Address - Fax:859-442-0046
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2640520Medicaid
KY64116536Medicaid
KY64116536Medicaid
KYI50124Medicare UPIN
KYP00303026Medicare PIN