Provider Demographics
NPI:1003892829
Name:SCHWARTZ, MARLENE (MD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:SCHWARTZ
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 1:112 MANSFIELD AVE
Mailing Address - Street 2:PULMONARY DISEASE DIVISION, HATCH WING
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2045
Mailing Address - Country:US
Mailing Address - Phone:860-456-7279
Mailing Address - Fax:860-450-0269
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:PULMONARY DISEASE DIVISION, HATCH WING
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2045
Practice Address - Country:US
Practice Address - Phone:860-456-7279
Practice Address - Fax:860-450-0269
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037545207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1003892829OtherNPI
CTF87318Medicare UPIN
CT1003892829OtherNPI