Healthcare Provider Details

I. General information

NPI: 1164441101
Provider Name (Legal Business Name): DAVID SCHWINDT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CLARA DRIVE SUITE 204
MYSTIC CT
06355
US

IV. Provider business mailing address

23 CLARA DRIVE SUITE 204
MYSTIC CT
06355
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-0010
  • Fax: 860-536-2799
Mailing address:
  • Phone: 860-572-0010
  • Fax: 860-536-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMD11245
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number0471821
License Number StateCT

VIII. Authorized Official

Name: DAVID SCHWINDT
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 86057200010