1205837887 NPI number — PAUL T SCHWERDT MD

Table of content: PAUL T SCHWERDT MD (NPI 1205837887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205837887 NPI number — PAUL T SCHWERDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWERDT
Provider First Name:
PAUL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205837887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 WASHINGTON ST.
Provider Second Line Business Mailing Address:
STE. 220
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-255-0561
Provider Business Mailing Address Fax Number:
781-255-0681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 WASHINGTON ST.
Provider Second Line Business Practice Location Address:
STE. 220
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-255-0561
Provider Business Practice Location Address Fax Number:
781-255-0681
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD11417 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 203570 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2030918 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411585 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 6149-4 . This is a "BLUE CROSS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: J22936 . This is a "BCBS BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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