Provider Demographics
NPI:1336260561
Name:SCHWENDER, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:SCHWENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:J
Other - Last Name:SCHWENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:40 CROSS ST
Mailing Address - Street 2:4TH FL
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4647
Mailing Address - Country:US
Mailing Address - Phone:203-845-4800
Mailing Address - Fax:203-845-4870
Practice Address - Street 1:40 CROSS ST
Practice Address - Street 2:4TH FL
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4647
Practice Address - Country:US
Practice Address - Phone:203-845-4800
Practice Address - Fax:203-845-4877
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46515207RG0100X
CT046515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1336260561Medicaid
NY228937OtherNYS LICENSE
100000490Medicare PIN
I00-267Medicare UPIN