Basic Information
Provider Information
NPI: 1104992023
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWARTZ
FirstName: MARTIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD OB GYN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 361 THIRD STREET
Address2: SUITE E
City: SAN RAFAEL
State: CA
PostalCode: 94901
CountryCode: US
TelephoneNumber: 4154994030
FaxNumber: 4155072634
Practice Location
Address1: 361 THIRD STREET
Address2: SUITE E
City: SAN RAFAEL
State: CA
PostalCode: 94901
CountryCode: US
TelephoneNumber: 4154994030
FaxNumber: 4155072634
Other Information
ProviderEnumerationDate: 11/24/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XG7945CAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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