Provider Demographics
NPI:1356365605
Name:SCHWARTZ, CHARLES I (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:I
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 1:824 MAIN ST
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-935-1330
Mailing Address - Fax:610-935-0493
Practice Address - Street 1:824 MAIN ST
Practice Address - Street 2:SUITE 100A
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-935-1330
Practice Address - Fax:610-935-0493
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065506L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016963300001Medicaid
PA351520Medicare PIN
PA0016963300001Medicaid