Healthcare Provider Details

I. General information

NPI: 1336260561
Provider Name (Legal Business Name): BRIAN JOHN SCHWENDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN J. SCHWENDER M.D.

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSS ST 4TH FL
NORWALK CT
06851-4647
US

IV. Provider business mailing address

40 CROSS ST 4TH FL
NORWALK CT
06851-4647
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-4800
  • Fax: 203-845-4877
Mailing address:
  • Phone: 203-845-4800
  • Fax: 203-845-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number46515
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046515
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: