Provider Demographics
NPI:1376627364
Name:SCHWARTZ, JOEL RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:RICHARD
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ERIE ST S
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7976
Mailing Address - Country:US
Mailing Address - Phone:330-833-3135
Mailing Address - Fax:
Practice Address - Street 1:3000 ERIE ST S
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7976
Practice Address - Country:US
Practice Address - Phone:330-833-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340041292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150223Medicaid
OH0150223Medicaid
OH364031Medicare ID - Type Unspecified