Provider Demographics
NPI:1396971164
Name:SCHWARTZ, TONY A (MD)
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:A
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:A
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:112 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2737
Mailing Address - Country:US
Mailing Address - Phone:860-425-8735
Mailing Address - Fax:860-425-8707
Practice Address - Street 1:42 TOWN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2316
Practice Address - Country:US
Practice Address - Phone:860-886-0567
Practice Address - Fax:860-886-0656
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
CT53550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program