Provider Demographics
NPI:1639153547
Name:SCHWARTZ, ILAN (MD)
Entity Type:Individual
Prefix:
First Name:ILAN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOSTON MEDICAL CENTER PL
Mailing Address - Street 2:DIVISION OF PEDIATRICS, DOWLING 3 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5170
Mailing Address - Fax:617-414-3803
Practice Address - Street 1:1 BOSTON MEDICAL CENTER PL
Practice Address - Street 2:CHILD HEALTH FOUNDATION OF BOSTON , DOWLING 3 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-5170
Practice Address - Fax:617-414-3803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA153746208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3168158Medicaid
MA3168158Medicaid
A37870Medicare ID - Type Unspecified