Provider Demographics
NPI:1639112881
Name:SCHWARTZ, FREDERIC TOVI (MD)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:TOVI
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 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1147
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-652-6621
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1147
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-652-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023456207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021739OtherBLUE SHIELD VA PROVIDER
MDD0023456OtherSTATE MEDICAL LICENSE
DC0461050Medicaid
MD21012OtherMAMSI UNITED HEALTHCARE
MD519604OtherAETNA PROVIDER #
DC6105OtherBLUE SHIELD DC PROVIDER
MD100984OtherKAISER PROVIDER #
MD7579OtherCAREFIRST MARYLAND PROVID
MD493563OtherNCPPO PROVIDER #
MDD0023456OtherSTATE MEDICAL LICENSE
MD21012OtherMAMSI UNITED HEALTHCARE