Healthcare Provider Details

I. General information

NPI: 1093848988
Provider Name (Legal Business Name): GAVIN SCHWARZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 FARMINGTON AVENUE SUITE 207
WEST HARTFORD CT
06119-1551
US

IV. Provider business mailing address

836 FARMINGTON AVENUE SUITE 207
WEST HARTFORD CT
06119-1551
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-9911
  • Fax: 860-233-5996
Mailing address:
  • Phone: 860-232-9911
  • Fax: 860-233-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number048479
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048479
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: