Healthcare Provider Details

I. General information

NPI: 1609855352
Provider Name (Legal Business Name): JONATHAN S. SCHWAB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 LOCUST ST #2
NORTHAMPTON MA
01060-2066
US

IV. Provider business mailing address

193 LOCUST ST #2
NORTHAMPTON MA
01060-2066
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-8700
  • Fax: 413-584-1714
Mailing address:
  • Phone: 413-584-8700
  • Fax: 413-584-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: