Healthcare Provider Details

I. General information

NPI: 1881622629
Provider Name (Legal Business Name): MARK D SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 13TH ST
BOULDER CO
80304-4104
US

IV. Provider business mailing address

1735 S PUBLIC RD
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-3036
  • Fax:
Mailing address:
  • Phone: 303-665-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37095
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37095
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02156202
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: