Provider Demographics
NPI:1326041625
Name:SCHWARTZ, MITCHELL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:EDWARD
Last Name:SCHWARTZ
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 1:372 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6212
Mailing Address - Country:US
Mailing Address - Phone:802-660-8808
Mailing Address - Fax:802-660-4310
Practice Address - Street 1:372 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6212
Practice Address - Country:US
Practice Address - Phone:802-660-8808
Practice Address - Fax:802-660-4310
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2018-06-19
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
VT0420009437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTD03388Medicare UPIN
VTVN1508Medicare ID - Type UnspecifiedMEDICARE ID NUMBER