Basic Information
Provider Information | |||||||||
NPI: | 1992780324 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHWARZ | ||||||||
FirstName: | KATHLEEN | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 313 BRENTWOOD RD | ||||||||
Address2: |   | ||||||||
City: | CHARLOTTESVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 229011104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 1434466510 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 78 MEDICAL CENTER DR | ||||||||
Address2: |   | ||||||||
City: | FISHERSVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 229392332 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5403324000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/08/2005 | ||||||||
LastUpdateDate: | 05/07/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 010317 | ME | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 0101039769 | VA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 221890000 | 05 | ME |   | MEDICAID | 3336619 | 01 |   | AETNA | OTHER | 060773 | 01 |   | ANTHEM BCBS | OTHER | 1992780324 | 05 | VA |   | MEDICAID | 4443189001 | 01 |   | CIGNA | OTHER |