Provider Demographics
NPI:1760499149
Name:SCHWARTZ, CARL R E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:R E
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:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-624-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:149 13TH ST
Practice Address - Street 2:BUILDING 149, ROOM 2627
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2020
Practice Address - Country:US
Practice Address - Phone:617-726-8965
Practice Address - Fax:617-726-4078
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA498892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6183069Medicaid
MA049889OtherTUFTS HEALTH PLAN
MAJ02916OtherBCBC
MAJ02916OtherBCBC