Provider Demographics
NPI:1588666085
Name:SCHWARTZ, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:1601 BRIGHAM DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7114
Mailing Address - Country:US
Mailing Address - Phone:419-872-7745
Mailing Address - Fax:419-874-7758
Practice Address - Street 1:1601 BRIGHAM DR
Practice Address - Street 2:SUITE 250
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7114
Practice Address - Country:US
Practice Address - Phone:419-872-7745
Practice Address - Fax:419-874-7758
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922808OtherAETNA
2835360474-003OtherMMOH
OH01-03306OtherUHC
OH0625603Medicaid
OH000000536522OtherANTHEM
OH080130461OtherRRMC
00330OtherPARAMOUNT
OH0625603Medicaid
OH01-03306OtherUHC
$$$$$$$$$OtherHEALTH NET TRICARE