Provider Demographics
NPI:1689678120
Name:SCHWENKER, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:SCHWENKER
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 1:6 ST ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1356
Mailing Address - Country:US
Mailing Address - Phone:518-793-9488
Mailing Address - Fax:518-792-6854
Practice Address - Street 1:6 ST ANDREWS DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1356
Practice Address - Country:US
Practice Address - Phone:518-793-9488
Practice Address - Fax:518-792-6854
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116122207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01000247OtherRR MEDICARE
NY00359820Medicaid
NYB79034Medicare UPIN
NY00359820Medicaid