Provider Demographics
NPI:1104361849
Name:L. MATTHEW SCHWARTZ, MD, LLC
Entity Type:Organization
Organization Name:L. MATTHEW SCHWARTZ, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-280-3475
Mailing Address - Street 1:1108 E WILLOW GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7663
Mailing Address - Country:US
Mailing Address - Phone:215-233-6226
Mailing Address - Fax:215-836-0300
Practice Address - Street 1:1108 E WILLOW GROVE AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7663
Practice Address - Country:US
Practice Address - Phone:215-233-6226
Practice Address - Fax:215-836-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042758E261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE81776Medicare UPIN