Provider Demographics
NPI:1205178175
Name:SWARTZ, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7825
Mailing Address - Country:US
Mailing Address - Phone:802-864-7058
Mailing Address - Fax:
Practice Address - Street 1:93 PILGRIM PARK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1727
Practice Address - Country:US
Practice Address - Phone:802-241-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0003361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006059Medicaid
VT0006059Medicaid