Basic Information
Provider Information
NPI: 1063481745
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWARTZ
FirstName: MICHAEL
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5550 FRIENDSHIP BLVD
Address2: T-90
City: CHEVY CHASE
State: MD
PostalCode: 208157256
CountryCode: US
TelephoneNumber: 3016542521
FaxNumber: 3016542986
Practice Location
Address1: 2021 K ST NW
Address2: SUITE T-110
City: WASHINGTON
State: DC
PostalCode: 200061003
CountryCode: US
TelephoneNumber: 2022963449
FaxNumber: 2022969122
Other Information
ProviderEnumerationDate: 03/16/2006
LastUpdateDate: 03/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100XD0025144MDY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

ID Information
IDTypeStateIssuerDescription
MD1125901DCSTATE LICENSEOTHER


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