Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 048479 | CT |
N | 207R00000X | Internist | 048479 | CT |
N | 111NI0900X | Internist | 048479 | CT |
N | 208000000X | Pediatrician | 240687 | NY |
NPI | 1093848988 |
---|---|
Provider Name | Gavin Schwarz |
First Address | West Hartford, CT 06119-1551 |
Second Address | West Hartford, CT 06119-1551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2010 |