Provider Demographics
NPI:1932182839
Name:SCHWARTZ, FREDERIC HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:HENRY
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 1:102 SHORE DR
Mailing Address - Street 2:STE 303
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3154
Mailing Address - Country:US
Mailing Address - Phone:508-856-0458
Mailing Address - Fax:508-856-0619
Practice Address - Street 1:102 SHORE DR
Practice Address - Street 2:STE 303
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3154
Practice Address - Country:US
Practice Address - Phone:508-856-0458
Practice Address - Fax:508-856-0619
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9732110Medicaid
MAA21724Medicare ID - Type Unspecified
MA9732110Medicaid