Provider Demographics
NPI:1629074414
Name:SCHWARTZ, THOMAS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
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 1:1219 S EAST AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2340
Mailing Address - Country:US
Mailing Address - Phone:941-957-4216
Mailing Address - Fax:941-954-1835
Practice Address - Street 1:1219 S EAST AVE
Practice Address - Street 2:STE 105
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2340
Practice Address - Country:US
Practice Address - Phone:941-957-4216
Practice Address - Fax:941-954-1835
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2855377002OtherCIGNA
FL371086600Medicaid
FL15090OtherBLUE CROSS BLUE SHIELD
FL162907144393OtherNPI
FL0624245OtherAETNA
FL180014175OtherTRAVELERS
FL371086600Medicaid