Healthcare Provider Details

I. General information

NPI: 1194746800
Provider Name (Legal Business Name): GLEN SCHWARTZBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 PERKINS RD
BATON ROUGE LA
70808-4326
US

IV. Provider business mailing address

7373 PERKINS RD
BATON ROUGE LA
70808-4326
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-4044
  • Fax:
Mailing address:
  • Phone: 225-769-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number015843
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.142147
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number67021
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: